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Tong X, Ran Y, Da J, Hu Y, Yuan J, Rui Y. Internal fistula stenosis with true pseudoaneurysm formation in a patient on maintenance hemodialysis: A case report. Medicine (Baltimore) 2024; 103:e38111. [PMID: 38728493 PMCID: PMC11081536 DOI: 10.1097/md.0000000000038111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Arteriovenous fistula stenosis can directly lead to the formation of autologous arteriovenous fistula aneurysms (AVFAs), but the coexistence of true and pseudoaneurysms is relatively rare. The coexistence of true and pseudoaneurysms increases the risk of rupture of the arteriovenous fistula and complicates subsequent surgical intervention, potentially posing a threat to the patient's life, and thus requires significant attention. CASE PRESENTATION The patient presented with arteriovenous fistula (AVF) after hemodialysis 6 years ago. 2 years ago, the patient presented with a mass that had formed near the left forearm arteriovenous fistula and gradually increased in size. Preoperatively, the AVF stenosis was identified as the cause of the mass formation, and the patient was operated on. First, the blood flow was controlled to reduce the pressure at the aneurysm, and then the incision was enlarged to separate the AVF anastomosis from the mass area. The stenotic segment of the true and pseudo aneurysms and cephalic vein was removed and the over-dilated proximal cephalic vein was locally narrowed and subsequently anastomosed with the proximal radial artery to create AVF. The patient was dialyzed with an internal fistula the next day and showed no clinical manifestations related to end-limb ischemia. CONCLUSION We removed a true pseudoaneurysm in AVF and secured the patient's vascular access. This report provides an effective strategy to manage this condition.
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Affiliation(s)
- Xiaoya Tong
- College of Clinical Medicine, Guizhou Medical University, Guiyang, China
- Department of Nephrology, People’s Hospital of Guizhou Province, Guiyang, China
- Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
| | - Yan Ran
- Department of Nephrology, People’s Hospital of Guizhou Province, Guiyang, China
- Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
| | - Jingjing Da
- Department of Nephrology, People’s Hospital of Guizhou Province, Guiyang, China
- Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
| | - Ying Hu
- Department of Nephrology, People’s Hospital of Guizhou Province, Guiyang, China
- Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
| | - Jing Yuan
- Department of Nephrology, People’s Hospital of Guizhou Province, Guiyang, China
- Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
| | - Yan Rui
- College of Clinical Medicine, Guizhou Medical University, Guiyang, China
- Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Wang YH, Lai YJ, Wang JK, Huang TL. A Case of Engorged Superior Ophthalmic Vein. J Neuroophthalmol 2023; 43:e334-e336. [PMID: 36730863 DOI: 10.1097/wno.0000000000001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Yu-Han Wang
- Department of Ophthalmology (Y-HW, J-KW, T-LH), Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Medical Imaging (Y-JL), Radiology Department, Far Eastern Memorial Hospital, Banciao Dist., New Taipei City, Taiwan; and Department of Electrical Engineering (J-KW, T-LH), Yuan-Ze University, Chung-Li, Taoyuan, Taiwan
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Hwang HP, Yu HC, Do Yang J, Lee MR, Chung BH. Dual outflow upper arm arteriovenous fistula: An effective technique to prevent cephalic arch stenosis. Medicine (Baltimore) 2023; 102:e36419. [PMID: 38050217 PMCID: PMC10695589 DOI: 10.1097/md.0000000000036419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Cephalic arch stenosis (CAS) is critical point to maintain functional arteriovenous fistula (AVF) in patients undergoing hemodialysis with brachio-cephalic AVFs. In this study, we aimed to determine the effectiveness of dual outflow (cephalic and basilic veins) as a surgical method to prevent CAS. Between July 2016 and December 2019, 369 patients underwent upper arm AVF creation. Among them the 251 patients were enrolled in this retrospective study. Two hundred seven underwent brachio-cephalic arteriovenous fistula (BCAVF) and 44 underwent brachio-cephalicbasilic arteriovenous fistula (BCBAVF). From the 251 patients, diabetes mellitus (66.7% vs 36.4%, P < .001) and hypertension (91.3% vs 75%, P = .002) were more common in the patient group who underwent BCAVF surgery; however, the difference in volume flow to the fistula did not differ between the 2 groups. CAS (30.4% vs 9.1%, P = .004) and fistula occlusion (15.9% vs 4.5%, P = .048) were likely to occur in the BCAVF group. The primary patency rates at 12 months were 74.3% and 86.4% for the BCAVFs and BCBAVFs, respectively (P = .075). The primary-assisted patency rates at 12 months were 87.0% for BCAVFs and 93.2% for BCBAVFs, respectively (P = .145). Secondary patency rates at 12 months were 92.2% for BCAVFs and 93.2% for BCBAVFs, respectively (P = .023). Compared to BCAVF, traditional upper arm AVF, upper arm AVF with cephalic and basilic vein dual drainage can be optimal surgical method to preventing CAS.
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Affiliation(s)
- Hong Pil Hwang
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk University Hospital, Jeonju, South Korea
| | - Hee Chul Yu
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk University Hospital, Jeonju, South Korea
| | - Jae Do Yang
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk University Hospital, Jeonju, South Korea
| | - Mi Rin Lee
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk University Hospital, Jeonju, South Korea
| | - Byeoung Hoon Chung
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk University Hospital, Jeonju, South Korea
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Ko DS, Baek SE, Ha M, Park JJ, Lee C, Kim HY, Jung Y, Kang JM, Kim YH. Osteopontin is a key regulator of vascular smooth muscle cell proliferation in the outflow vein of arteriovenous fistulas. Microvasc Res 2023:104570. [PMID: 37315777 DOI: 10.1016/j.mvr.2023.104570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Despite advances in the maintenance of arteriovenous fistulas (AVFs), the patency rates remain suboptimal. Most AVFs fail due to outflow vein stenosis; however, the underlying mechanism of AVF stenosis remains unclear. The present study aimed to identify key factors associated with AVF outflow stenosis. METHODS We obtained gene expression profiling data for the outflow vein of AVF from three Gene Expression Omnibus database datasets (GSE39488, GSE97377, and GSE116268) and analyzed the common differentially expressed genes (DEGs). We evaluated a common DEG in an aortocaval mouse model and the stenotic outflow veins of AVFs collected from patients. Furthermore, we isolated vascular smooth muscle cells (VSMCs) from the inferior vena cava (IVC) of wild-type (WT) and osteopontin (Opn)-knockout (KO) mice and assessed the proliferation of VSMCs following stimulation with platelet-derived growth factors (PDGFs). RESULTS OPN was the only common upregulated DEG among all datasets. OPN was expressed in the medial layer of the outflow vein of AVF in aortocaval mouse models and co-stained with the VSMC marker (α-smooth muscle actin). OPN expression was markedly increased in the VSMCs of stenotic outflow veins of AVF collected from patients undergoing hemodialysis compared to presurgical veins acquired during AVF formation surgery. PDGF-induced VSMC proliferation was significantly increased in the VSMCs isolated from the IVC of WT mice but not in those isolated from the IVC of Opn-KO mice. CONCLUSIONS OPN may be a key gene involved in VSMC proliferation in the AVF outflow veins and a therapeutic target to improve the AVF patency rate.
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Affiliation(s)
- Dai Sik Ko
- Division of Vascular Surgery, Department of General Surgery, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
| | - Seung Eun Baek
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Mihyang Ha
- Department of Nuclear Medicine and Pusan National University Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong Jun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Changjin Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hye Young Kim
- Department of Anatomy, Inje University College of Medicine, Busan, Republic of Korea
| | - YunJae Jung
- Department of Microbiology, College of Medicine, Gachon University, Incheon, Republic of Korea; Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Republic of Korea; Department of Health Science and Technology, Gachon Advanced Institute for Health Science & Technology, Gachon University, Incheon, Republic of Korea
| | - Jin Mo Kang
- Division of Vascular Surgery, Department of General Surgery, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea.
| | - Yun Hak Kim
- Department of Nuclear Medicine and Pusan National University Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; Department of Anatomy and Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
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Lee K, Won JH, Kwon Y, Lee SH, Bang JB, Kim J. Bare-Metal Stent in Dysfunctional Hemodialysis Access: An Assessment of Circuit Patency according to Access Type and Stent Location. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:197-211. [PMID: 36818700 PMCID: PMC9935964 DOI: 10.3348/jksr.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
Purpose To evaluate the circuit patency after nitinol bare-metal stent (BMS) placement according to the type of access and location of the stent in dysfunctional hemodialysis access. Materials and Methods Between January 2017 and December 2019, 159 patients (mean age, 64.1 ± 13.2 years) underwent nitinol BMS placement for dysfunctional access. The location of stents was as follows: 18 brachiocephalic vein, 51 cephalic arch, 40 upper arm vein, 10 juxta-anastomotic vein, 7 arteriovenous (AV) anastomosis, and 33 graft-vein (GV) anastomosis. Circuit patency was evaluated by the Kaplan-Meier method, and cox regression model. Results A total of 159 stents were successfully deployed in 103 AV fistula (AVF) and 56 AV graft (AVG). AVG showed lower primary and secondary patency at 12-months compared with AVF (primary patency; 25.0% vs. 44.7%; p = 0.005, secondary patency; 76.8% vs. 92.2%; p = 0.014). Cox regression model demonstrated poorer primary patency at 12 months after stenting in the cephalic arch and GV anastomosis compared with the other sites. Conclusion AVF showed better primary and secondary circuit patency at 12 months following the placement of BMS compared with AVG. Stents in the cephalic arch and GV anastomosis were associated with poorer primary patency at 12 months compared to those in other locations.
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Affiliation(s)
- Kyungmin Lee
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Su Hyung Lee
- Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jun Bae Bang
- Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Abdelsalam H. Cephalic arch stenosis in autologous hemodialysis fistula; to stent or not to stent? Long-term follow up. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A retrospective study of 44 patients with autologous arteriovenous fistula (AVF) presenting with cephalic arch stenosis was carried out. The aim is to assess the effectiveness of angioplasty and stenting in cephalic arch stenosis in autologous AVF in hemodialysis patients and also to assess the outcome of metal stents at this distinctive anatomical site. All patients were subjected to Doppler examination, where the stenotic lesion and the AVF flow volume were assessed prior to intervention. The follow-up period reached up to 57 months in some patients. All patients were under surveillance and were assessed for patency and flow volume. The primary and secondary stenosis-free rates were calculated. Re-intervention during the follow-up period was recorded.
Results
The technical success rate was 100%. Twenty-six patients had balloon angioplasty. Eighteen patients had primary and/or secondary stents inserted. The primary patency rate at 6 and 12 months for the balloon angioplasty group was 80% and 60% and for the stent group was 86% and 71%, respectively. The mean primary patency rate in balloon angioplasty patients was 12.9 months, while in the primary stented patients was 19.9 months. Twenty-six patients had secondary intervention. The average secondary patency rate for patients with balloon angioplasty was 25.5 months, while it was 33.6 months in the stented patients.
Conclusion
Cephalic arch angioplasty and stenting is an effective intervention increasing the longevity of the AVF that is crucial for hemodialysis patients. The use of metal stents whether bare metal stents or covered stents is safe and adds significant increase in patency rates.
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7
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Gunawardena T, Ridgway D. Swing segment stenosis: An unresolved challenge. Semin Dial 2022; 35:307-316. [PMID: 35475553 DOI: 10.1111/sdi.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/08/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
The native arteriovenous fistula is considered the gold standard among all dialysis access options. Compared with alternatives such as grafts and central venous catheters, their use is associated with a lower risk of infective and thrombotic complications. This leads to better patient outcomes and reduced healthcare-associated costs. Recognizing these advantages, there is a global drive to increase the creation and use of such fistulas in hemodialysis patients. Swing segment stenosis is a common problem encountered with the creation and use of these fistulas that can hurt their maturation and longevity. A "swing segment" in an arteriovenous fistula is defined as a segment of vein that pursues a sharp, curved course. Due to poorly understood reasons, these swing segments tend to develop stenotic lesions that are extremely challenging to treat. This review aims to provide an overview of the pathophysiology, incidence, management, and prevention of these swing segment lesions. We believe that such knowledge will be useful for clinicians who deal with dialysis access creation and maintenance.
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Affiliation(s)
- Thilina Gunawardena
- Fellow in Renal Transplant and Vascular Access Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Dan Ridgway
- Consultant Renal Transplant and Vascular Access Surgeon, Royal Liverpool University Hospital, Liverpool, UK
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Beathard GA, Jennings WC, Wasse H, Shenoy S, Falk A, Urbanes A, Ross J, Nassar G, Hentschel DM, Sachdeva B, Chan MR, Salman L, Asif A. ASDIN white paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology. J Vasc Access 2021; 24:358-369. [PMID: 34392712 DOI: 10.1177/11297298211033519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Brachiocephalic arteriovenous fistulas (AVF) makeup approximately one third of prevalent dialysis vascular accesses. The most common cause of malfunction with this access is cephalic arch stenosis (CAS). The accepted requirement for treatment of a venous stenosis lesion is ⩾50% stenosis associated with hemodynamically abnormalities. However, the correlation between percentage stenosis and a clinically significant decrease in access blood flow (Qa) is low. The critical parameter is the absolute minimal luminal diameter (MLD) of the lesion. This is the parameter that exerts the key restrictive effect on Qa and results in hemodynamic and functional implications for the access. CAS is the result of low wall shear stress (WSS) resulting from the effects of increased blood flow and the unique anatomical configuration of the CAS. Decrease in WSS has a linear relationship to increased blood flow velocity and neointimal hyperplasia exhibits an inverse relationship with WSS. The result is a stenotic lesion. The presence of downstream venous stenosis causes an inflow-outflow mismatch resulting in increased pressure within the access. Qa in this situation may be decreased, increased, or within a normal range. Over time, the increased intraluminal pressure can result in marked aneurysmal changes within the AVF, difficulties with cannulation and the dialysis treatment, and ultimately, increasing risk of access thrombosis. Complete characterization of the lesion both hemodynamically and anatomically should be the first step in developing a strategy for management. This requires both access flow measurement and angiographic imaging. Patients with CAS present a relatively broad spectrum as relates to both of these parameters. These data should be used to determine whether primary treatment of CAS should be directed toward the anatomical lesion (small MLD and low Qa) or the pathophysiology (large MLD and high Qa).
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Affiliation(s)
| | - William C Jennings
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | | | - Surendra Shenoy
- Washington University and Barnes-Jewish Hospital, Saint Louis, MO, USA
| | | | - Aris Urbanes
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - John Ross
- Regional Medical Center of Orangeburg and Calhoun Counties, Dialysis Access Institute, Orangeburg, SC, USA
| | - George Nassar
- Weill Cornell Medicine and Houston Methodist Hospital, Houston, TX, USA
| | | | - Bharat Sachdeva
- LSU Health Shreveport School of Medicine, Shreveport, LA, USA
| | - Micah R Chan
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | | | - Arif Asif
- Department of Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Neptune, NJ, USA
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Kim Y, Kim HD, Chung BH, Park CW, Yang CW, Kim YS. Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate. J Vasc Access 2021; 23:718-724. [PMID: 33840270 DOI: 10.1177/11297298211008758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Despite the widespread use of conventional percutaneous transluminal angioplasty (PTA), recurrence of cephalic arch stenosis (CAS), and low patency rate after PTA remain challenging problem. We aimed to identify the clinical predictors of recurrence of CAS and evaluate the effect of the access flow reduction on the fistula patency rate in patients with recurrent CAS. METHODS In 1118 angiographies of 220 patients with CAS, access circuit patency rates after PTA and potential clinical predictors of recurrence of CAS were assessed. The effect of the banding procedure was evaluated in terms of post-interventional primary patency rate, and the number of interventions per access-year. RESULTS At 3, 6, and 12 months after the first PTA on CAS, the post-interventional access circuit primary patency rates were 68.8%, 40.5%, and 25.1%, respectively. High CV to CA ratio (the ratio of the maximal diameter of the distal cephalic vein to the diameter of the cephalic arch) (Hazard ratio (HR), 1.437; 95% confidence interval (CI), 1.036-1.992) and involvement of the proximal segment of cephalic arch (HR, 1.828; 95% CI, 1.194-2.801) were significant predictors of recurrent CAS. For those with recurrent CAS (>3 times/year) and an access flow rate >1.5 L/minute, endovascular banding procedure was performed. The banding procedure significantly reduced the number of interventions per access-year (t = 3.299, p = 0.005 and t = 2.989, p = 0.007, respectively). Post-interventional access circuit primary patency rate after banding was significantly higher than that before banding (p = 0.01). CONCLUSIONS High CV to CA ratio and involvement of the proximal segment of the cephalic arch are independent clinical predictors of recurrent CAS. Endovascular banding might delay recurrence of CAS in patients with high CV to CA ratio and high access flow.
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Affiliation(s)
- Yaeni Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Duk Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Soo Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hammes M, Cassel K, Boghosian M, Watson S, Funaki B, Coe F. A cohort study showing correspondence of low wall shear stress and cephalic arch stenosis in brachiocephalic arteriovenous fistula access. J Vasc Access 2020; 22:380-387. [PMID: 32693668 DOI: 10.1177/1129729820942048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A brachiocephalic fistula is frequently placed for hemodialysis; unfortunately, cephalic arch stenosis commonly develops, leading to failure. We hypothesized that a contribution to brachiocephalic fistula failure is low wall shear stress resulting in neointimal hyperplasia leading to venous stenosis. The objective of this investigation is to determine correspondence of low wall shear stress and the development of cephalic arch stenosis. METHODS Forty subjects receiving hemodialysis with a primary brachiocephalic fistula access were followed from time of placement for 3 years or until cephalic arch stenosis. Venogram, Doppler, and viscosity were performed at time of fistula maturation, annually for 3 years or to time of cephalic arch stenosis. Computational hemodynamics modeling was performed to determine location and percent low wall shear stress in the arch. The relationship between wall shear stress at time of maturation and location of cephalic arch stenosis were estimated by correlating computational modeling and quadrant location of cephalic arch stenosis. RESULTS In total, 32 subjects developed cephalic arch stenosis with 26 displaying correspondence between location of low wall shear stress at time of maturation and subsequent cephalic arch stenosis, whereas 6 subjects did not (p = 0.0015). Most subjects with correspondence had low wall shear stress areas evident in greater than 20% of the arch (p = 0.0006). Low wall shear stress was associated with a higher risk of cephalic arch stenosis in the 23-to-45 age group (p = 0.0029). CONCLUSIONS The presence and magnitude of low wall shear stress in the cephalic arch is a factor associated with development of cephalic arch stenosis in patients with brachiocephalic fistula. Attenuation of low wall shear stress at time of maturation may help prevent the development of cephalic arch stenosis which is difficult to treat once it develops.
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Affiliation(s)
- Mary Hammes
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, IL, USA
| | - Kevin Cassel
- Department of Mechanical, Materials and Aerospace Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Michael Boghosian
- Department of Mechanical, Materials and Aerospace Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Brian Funaki
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Frederic Coe
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, IL, USA
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11
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Feng PC, Lee CH, Hsieh HC, Ko PJ, Yu SY, Lin YS. Promising results of stent graft placement for cephalic arch stenosis after repeated failure of angioplasty in patients on hemodialysis. J Int Med Res 2020. [PMCID: PMC7294387 DOI: 10.1177/0300060520920419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Cephalic arch stenosis (CAS) causes repeated dysfunction and failure of arteriovenous access. Percutaneous transluminal angioplasty is the standard initial treatment for CAS, but its outcome is unsatisfactory. This study aimed to evaluate the outcome of stent graft placement for CAS in patients on hemodialysis. Methods A retrospective chart review from a tertiary medical center was performed in patients receiving stent graft placement for CAS between January 2012 and 2016. Patency was analyzed using the Kaplan–Meier method. Results Twenty-one patients received stent graft placement for CAS. Technical and clinical success rates were 100%. Primary target lesion patency was 95% (95% confidence interval [CI], 86%–100%), 76% (95% CI, 58%–94%), and 43% (95% CI, 22%–64%) at 3, 6, and 12 months, respectively. No significant difference in patency was observed between the arteriovenous fistula and arteriovenous graft groups. Assisted primary patency was 95% (95% CI, 86%–100%), 71% (95% CI, 52%–91%), and 57% (95% CI, 36%–78%) at 3, 6, and 12 months, respectively. Secondary patency was 100% at 3, 6, and 12 months. Conclusions After repeated failed angioplasty for cephalic arch stenosis, patients on hemodialysis who receive stent graft placement have effective and durable outcomes.
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Affiliation(s)
- Pin-Chao Feng
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hui Lee
- Department of Anesthesiology, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chang Hsieh
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yueh Yu
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Sheng Lin
- Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Cardiology, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
- Healthcare Center, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
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Tang TY, Tan CS, Yap C, Tan RY, Tay HH, Choke E, Chong TT. Helical stent (SUPERA™) and drug-coated balloon (Passeo-18 Lux™) for recurrent cephalic arch stenosis: Rationale and design of arch V SUPERA-LUX Study. J Vasc Access 2019; 21:504-510. [PMID: 31621477 DOI: 10.1177/1129729819881589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment options for cephalic arch stenosis are limited and standard of care remains at crossroads - none are ideal and there is currently no gold standard. Endovascular techniques are now the preferred primary therapeutic option because they are minimally invasive and better tolerated by haemodialysis patients who have multiple comorbidities. However, conventional plain old balloon angioplasty, bare metal stenting and stent grafts all have their limitations. The aim of this trial is to evaluate whether the helical SUPERA™ stent (Abbott Vascular, Santa Clara, CA, USA), which has a higher degree of flexibility and resistance to compressive forces compared to traditionally laser-cut nitinol stents, combined with a drug-coated balloon (Biotronik Passeo-18 Lux™) to minimize the neointimal hyperplasia effect, can improve patency and reduce reintervention rates. METHODS AND RESULTS Arch V SUPERA-LUX is a pilot investigator-initiated single-centre, single-arm prospective study. Twenty patients with a brachiocephalic fistula within 6 months of initial plain old balloon angioplasty for significant cephalic arch stenosis will be recruited for treatment with SUPERA and drug-coated balloon. The primary objectives are immediate angiographic and procedural success, primary patency and functional fistula at 1 week, 8 weeks, 6 and 12 months. The results from eight patients treated prospectively as proof of concept have shown primary patency of 83.3% at 1 year with 100% technical and procedural success rates. Enrolment for the Arch V SUPERA-LUX study is expected to be completed at the end of 2019. CONCLUSION The Arch V SUPERA-LUX study is the first trial to evaluate whether SUPERA stent implantation and drug-coated balloon use can provide superior protection against restenosis compared to traditional angioplasty, bare metal stents and stent grafts in recurrent cephalic arch stenosis. Initial pilot results are encouraging but longer follow-up is required to truly test this technique. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov NCT03891693.
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Affiliation(s)
- T Y Tang
- Duke-NUS Medical School, Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - C S Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Cjq Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - R Y Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - H H Tay
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Etc Choke
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - T T Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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Kim SM, Yoon KW, Woo SY, Heo SH, Kim YW, Kim DI, Park YJ. Treatment Strategies for Cephalic Arch Stenosis in Patients with Brachiocephalic Arteriovenous Fistula. Ann Vasc Surg 2019; 54:248-253. [DOI: 10.1016/j.avsg.2018.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 10/28/2022]
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14
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D’cruz RT, Leong SW, Syn N, Tiwari A, Sannasi VV, Singh Sidhu HR, Tang TY. Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis. J Vasc Access 2018; 20:345-355. [DOI: 10.1177/1129729818814466] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Sze Wai Leong
- Department of Surgery, Ng Teng Fong General Hospital, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alok Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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15
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Sarala S, Sangeetha B, Mahapatra VS, Nagaraju RD, Kumar ACV, Lakshmi AY, Ram R, Kumar VS. Cephalic Arch Stenosis: Location of Stenosis in Indian Hemodialysis Patients. Indian J Nephrol 2018; 28:273-277. [PMID: 30158744 PMCID: PMC6094841 DOI: 10.4103/ijn.ijn_321_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The cephalic vein is formed over the "anatomical snuff box" and joins the axillary vein just below the clavicular level. The definition of cephalic arch is varied. In the radiology literature, it is defined as the central perpendicular portion of the cephalic vein as it traverses the deltopectoral groove and joins the axillary vein. The possible etiologies of cephalic arch stenosis are numerous. This study aimed to identify patients with cephalic arch stenosis and to discern the domain site of stenosis. This is a retrospective case series of patients who had an arteriovenous fistula with dysfunction of access and ipsilateral upper-limb edema. The clinical features of the access dysfunction were strong pulse due to increased pressure, weak thrill due to poor proximal flow, high static pressure, or decreased dialysis efficiency. All these 25 patients underwent computed tomography (CT) angiogram. The CT angiographic findings revealed cephalic arch stenosis and stenosis in 13 patients (52%). domain IV was slightly more affected than other domains of cephalic arch.
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Affiliation(s)
- S Sarala
- Department of Radiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - B Sangeetha
- Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh, India
| | - V S Mahapatra
- Department of Vascular Surgery, NIMS, Hyderabad, Telangana, India
| | - R D Nagaraju
- Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh, India
| | - A C V Kumar
- Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh, India
| | - A Y Lakshmi
- Department of Radiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - R Ram
- Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh, India
| | - V S Kumar
- Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh, India
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16
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Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrologia 2018; 37 Suppl 1:1-191. [PMID: 29248052 DOI: 10.1016/j.nefro.2017.11.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.
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17
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Arnaoutakis DJ, Deroo EP, McGlynn P, Coll MD, Belkin M, Hentschel DM, Ozaki CK. Improved outcomes with proximal radial-cephalic arteriovenous fistulas compared with brachial-cephalic arteriovenous fistulas. J Vasc Surg 2017; 66:1497-1503. [DOI: 10.1016/j.jvs.2017.04.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/23/2017] [Indexed: 11/16/2022]
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18
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Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas. J Vasc Access 2017; 18:319-324. [PMID: 28665461 DOI: 10.5301/jva.5000734] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis. METHODS Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software. RESULTS The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50% of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis. CONCLUSIONS Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.
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Zhao J, Jourd'heuil FL, Xue M, Conti D, Lopez-Soler RI, Ginnan R, Asif A, Singer HA, Jourd'heuil D, Long X. Dual Function for Mature Vascular Smooth Muscle Cells During Arteriovenous Fistula Remodeling. J Am Heart Assoc 2017; 6:e004891. [PMID: 28360226 PMCID: PMC5533005 DOI: 10.1161/jaha.116.004891] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The arteriovenous fistula (AVF) is the preferred form of hemodialysis access for patients with chronic kidney disease. However, AVFs are associated with significant problems including high incidence of both early and late failures, usually attributed to inadequate venous arterialization and neointimal hyperplasia, respectively. Understanding the cellular basis of venous remodeling in the setting of AVF could provide targets for improving AVF patency rates. METHODS AND RESULTS A novel vascular smooth muscle cell (VSMC) lineage tracing reporter mouse, Myh11-Cre/ERT2-mTmG, was used to track mature VSMCs in a clinically relevant AVF mouse model created by a jugular vein branch end to carotid artery side anastomosis. Prior to AVF surgery, differentiated medial layer VSMCs were labeled with membrane green fluorescent protein (GFP) following tamoxifen induction. Four weeks after AVF surgery, we observed medial VSMC layer thickening in the middle region of the arterialized vein branch. This thickened medial VSMC layer was solely composed of differentiated VSMCs that were GFP+/MYH11+/Ki67-. Extensive neointimal hyperplasia occurred in the AVF region proximal to the anastomosis site. Dedifferentiated VSMCs (GFP+/MYH11-) were a major cellular component of the neointima. Examination of failed human AVF samples revealed that the processes of VSMC phenotypic modulation and intimal hyperplasia, as well as medial VSMC layer thickening, also occurred in human AVFs. CONCLUSIONS We demonstrated a dual function for mature VSMCs in AVF remodeling, with differentiated VSMCs contributing to medial wall thickening towards venous maturation and dedifferentiated VSMCs contributing to neointimal hyperplasia. These results provide valuable insights into the mechanisms underlying venous adaptations during AVF remodeling.
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Affiliation(s)
- Jinjing Zhao
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY
| | | | - Min Xue
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY
- Feed Research Institute, Chinese Academy of Agricultural Sciences, Beijing, China
| | - David Conti
- Department of Surgery, Transplantation Group, Albany Medical College, Albany, NY
| | | | - Roman Ginnan
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY
| | - Arif Asif
- Jersey Shore University Medical Center, Hackensack-Meridian Health Seton Hall-Hackensack Meridian School of Medicine, Neptune, NJ
| | - Harold A Singer
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY
| | - David Jourd'heuil
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY
| | - Xiaochun Long
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY
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20
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Jun ESW, Lun ALY, Nikam M. A rare anatomic variant of a single-conduit supraclavicular cephalic arch draining into the external jugular vein presenting with recurrent arteriovenous fistula stenosis in a hemodialysis patient. J Vasc Surg Cases Innov Tech 2017; 3:20-22. [PMID: 29349367 PMCID: PMC5757772 DOI: 10.1016/j.jvscit.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022] Open
Abstract
The cephalic arch is a common location of stenosis, especially in brachiocephalic fistulas. The cephalic arch has a number of anatomic variations. Cephalic arch stenoses are often resistant and have poor primary patency. Here we describe an unusual case of a hemodialysis patient with a single-conduit supraclavicular cephalic arch draining into the external jugular vein presenting with recurrent cephalic arch stenoses and external jugular vein stenosis. In our view, extrinsic compression by the clavicle may contribute to the high rate of recurrence, the lack of complete dilation of even high-pressure balloons, and a theoretically heightened risk of rupture when cutting balloons are used.
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21
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Endovascular Stent Placement for Hemodialysis Arteriovenous Access Stenosis. Int J Vasc Med 2015; 2015:971202. [PMID: 26649199 PMCID: PMC4663359 DOI: 10.1155/2015/971202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 10/18/2015] [Accepted: 10/19/2015] [Indexed: 12/22/2022] Open
Abstract
This study aims to report the outcomes of nitinol and polytetrafluoroethylene covered stent placement to treat hemodialysis arteriovenous access stenosis at a single center over a five-year period. Clinical and radiological information was reviewed retrospectively. Poststent primary and secondary patency rates were determined using Kaplan-Meier analysis. Ten clinical variables were subjected to multivariate Cox regression analysis to determine predictors of patency after stent placement. During the study period 60 stents were deployed in 45 patients, with a mean follow-up of 24.5 months. The clinical and anatomical success rate was 98.3% (59/60). Poststent primary patency rates at 6, 12, and 24 months were 64%, 46%, and 35%, respectively. Poststent secondary patency rates at 6, 12, and 24 months were 95%, 89%, and 85%, respectively. Stent placement for upper arm lesions and in access less than 12 months of age was associated with reduced primary patency (adjusted hazards ratio [HR] 5.1, p = 0.0084, and HR 3.5, p = 0.0029, resp.). Resistant or recurrent stenosis can be successfully treated by endovascular stent placement with durable long-term patency, although multiple procedures are often required. Stent placement for upper arm lesions and in arteriovenous access less than 12 months of age was associated with increased risk of patency loss.
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22
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Vasanthamohan L, Gopee-Ramanan P, Athreya S. The Management of Cephalic Arch Stenosis in Arteriovenous Fistulas for Hemodialysis: A Systematic Review. Cardiovasc Intervent Radiol 2015. [DOI: 10.1007/s00270-015-1190-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cândido C, Viegas M, Sobrinho G, Natário A, Barreto C, Felgueiras J, Vinhas J. Transposition of the cephalic vein in therapeutic rescue of cephalic arch stenosis. Clin Kidney J 2015; 7:501-3. [PMID: 25878790 PMCID: PMC4379347 DOI: 10.1093/ckj/sfu089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/06/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Cristina Cândido
- Department of Nephrology , Centro Hospitalar de Setúbal , Setúbal , Portugal
| | - Márcio Viegas
- Department of Nephrology , Centro Hospitalar de Setúbal , Setúbal , Portugal
| | - Gonçalo Sobrinho
- Department of Nephrology , Centro Hospitalar de Setúbal , Setúbal , Portugal
| | - Ana Natário
- Department of Nephrology , Centro Hospitalar de Setúbal , Setúbal , Portugal
| | - Carlos Barreto
- Department of Nephrology , Centro Hospitalar de Setúbal , Setúbal , Portugal
| | - Joana Felgueiras
- Department of Nephrology , Centro Hospitalar de Setúbal , Setúbal , Portugal
| | - José Vinhas
- Department of Nephrology , Centro Hospitalar de Setúbal , Setúbal , Portugal
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Affiliation(s)
- Adrian Sequeira
- Division of Nephrology and Hypertension; Department of Medicine; Louisiana State University Health Sciences Center; Shreveport Louisiana
| | - Tze-Woei Tan
- Division of Vascular surgery; Department of Surgery; Louisiana State University Health Sciences Center; Shreveport Louisiana
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25
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Vo T, Tumbaga G, Aka P, Behseresht J, Hsu J, Tayarrah M. Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications. J Vasc Surg 2015; 61:457-62. [DOI: 10.1016/j.jvs.2014.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/11/2014] [Indexed: 11/25/2022]
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26
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Characterization of the cephalic arch and location of stenosis. J Vasc Access 2014; 16:13-8. [PMID: 25198819 DOI: 10.5301/jva.5000291] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study is to accurately characterize the cephalic arch segments into four domains and to enable more specific evaluation of cephalic arch stenosis (CAS) and determine the frequency of stenosis in each domain. METHODS After Institutional Review Board (IRB) approval, a retrospective chart review was done to define a population of patients receiving hemodialysis who developed CAS as apparent on clinically indicated radiologic imaging. A standardized approach was devised to categorize four domains of the cephalic arch. Domain I was defined as the peripheral portion of the arch and Domain IV was the distal portion of the cephalic vein near termination with the axillary vein. The magnitude of stenosis as measured by percentage was determined and compared in the four domains. RESULTS The most frequent location for stenosis was found in domain IV when compared with domains II or I (p<0.01). The magnitude of stenosis differed across all domains (p<0.001) with the least common place for CAS in domain I. Treatment of CAS included angioplasty in all, thrombectomy in eight, and stent placement in five. CONCLUSIONS CAS occurs most commonly in the terminal portion of the arch. Four standardized domains have been defined; future work will validate these findings and determine the best intervention for each domain.
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