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A Randomized Prospective Study Comparing Outcomes of Angioplasty versus VIABAHN Stent-Graft Placement for Cephalic
Dheeraj K Rajan1, Abigail Falk2
1Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, 585 University Ave., NCSB 1C- 553, Toronto, ON, Canada M5G 2N2.
Insights
The VIABAHN stent graft demonstrated superior patency rates for cephalic arch stenosis (CAS) compared to angioplasty in hemodialysis access patients. This indicates a more durable solution for maintaining access circuit patency.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Cephalic arch stenosis (CAS) is a common complication in hemodialysis access.
- Maintaining access circuit patency is crucial for effective hemodialysis.
- Previous interventions for CAS have shown variable success rates.
Purpose of the Study:
- To compare the efficacy of the VIABAHN stent graft versus angioplasty for treating CAS.
- To evaluate postintervention primary patency and access circuit patency at 3, 6, and 12 months.
Main Methods:
- A randomized prospective study included 14 patients with dysfunctional hemodialysis accesses and CAS.
- Patients with brachiocephalic fistulae were randomized to angioplasty (PTA) or stent-graft placement.
- Patency was assessed using transonic flow and/or fistulography, with Kaplan-Meier estimation for analysis.
Main Results:
- Both PTA and stent-graft interventions achieved anatomic and clinical success.
- Mean patency intervals were 100 days for PTA versus 300 days for stent grafts.
- Stent grafts showed significantly higher primary access circuit patency (100%, 67%, 22% at 3, 6, 12 months) and target lesion patency (100%, 100%, 29%) compared to PTA (20%, 0%, 0% and 60%, 0%, 0%, respectively).
Conclusions:
- The VIABAHN stent graft offers statistically superior primary patency rates for CAS treatment.
- Stent graft placement is a more effective long-term solution for maintaining hemodialysis access patency compared to balloon angioplasty.
Purpose:
To determine if postintervention cephalic arch stenosis (CAS) primary patency and access circuit patency are superior with the VIABAHN stent graft compared with angioplasty at 3, 6, and 12 months.
Materials And Methods:
All patients presenting with dysfunctional hemodialysis accesses with CAS over a 4-year period were assessed for inclusion in a randomized prospective study. A total of 14 patients were recruited across three centers. All patients had mature brachiocephalic fistulae. Five were randomized to undergo percutaneous transluminal angioplasty and nine to undergo stent-graft placement. Patency of the treated cephalic arch was assessed with transonic flow and/or follow-up fistulography. Variables assessed were diabetes, previous interventions performed on the access, access age and side, and sex. Patency was determined with Kaplan-Meier estimation.
Results:
Anatomic and clinical success was obtained in all interventions. Mean patency intervals were 100 days in the PTA group and 300 days in the stent-graft group. Primary access circuit patency rates at 3, 6, and 12 months were significantly different: 20%, 0%, and 0% for PTA and 100%, 67%, and 22% for stent grafts (P < .01). Primacy target lesion patency rates at 3, 6, and 12 months were also significantly different: 60%, 0%, and 0% for PTA and 100%, 100%, and 29% for stent grafts (P < .01). No complications or adverse events were observed.
Conclusions:
Treatment of CAS with the VIABAHN stent graft appears to provide statistically superior primary patency rates compared with balloon angioplasty.
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