Abstract
Cephalic arch stenosis is a common complication in maintenance hemodialysis (MHD) patients with brachial artery-cephalic vein fistulas and frequently leads to loss of the functioning brachial artery-cephalic vein fistula. There is paucity of conclusive data to guide appropriate management. We examined the risk of recurrence of cephalic arch stenosis after angioplasty compared to angioplasty after stent placement determined by angiography of the involved upper extremity over time in a contemporary cohort of MHD patients treated in two interventional nephrology practices from March 2008 through May 2011. We retrospectively identified 45 MHD patients with evidence of cephalic arch stenosis (age 60 ± 30 years, 45% men) on elective angiograms. The median number of days until another angioplasty was required decreased, starting with a median of 91.5 days after the first, 70.5 days after the second, 85 days after the third, and 56 days after the fourth. Angioplasty is associated with a faster rate of recurrence of cephalic arch stenosis. The placement of intravascular stent seems to prolong the patency compared to angioplasty alone. Clinical trials with a larger sample size will better elucidate the value and timing of angioplasty versus stent placement in cephalic arch stenosis.
Highlights
Patient 1 28 Patient 2 74 Patient 3 71 Patient 4 66 Patient 5 88 Patient 6 86 Patient 7 43 Patient 8 78 Patient 9 51 Patient 61 Patient 64 Patient 70 Patient 87 Patient 56 Patient 86 Patient 59 Patient 58 Patient 54
Ment determined by angiography of the involved upper extremity over time in a contemporary cohort of maintenance hemodialysis (MHD) patients treated in two interventional nephrology practices from March 2008 through May 2011
We retrospectively identified 45 MHD patients with evidence of cephalic arch stenosis on elective angiograms (Table 1)
Summary
AVF is arteriovenous fistula, LBC is left brachial artery-cephalic vein arteriovenous fistula. Lack of optimal angioplasty outcomes have lead to the use of intravascular stent placement to be used for treatment of cephalic arch stenosis. Stenosis can occur within the stent and frequent recurrence of this stenosis may lead one to consider surgical options such as vein patch angioplasty and transposition of the cephalic vein to axillary or subclavian vein to manage this lesion [10,11]. This study examines the value and timing of angioplasty versus angioplasty along with stent placement in management of cephalic arch stenosis. Ment determined by angiography of the involved upper extremity over time in a contemporary cohort of MHD patients treated in two interventional nephrology practices from March 2008 through May 2011
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