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Cephalic vein transposition is a durable approach to managing cephalic arch stenosis
Jon C Henry1, Ulka Sachdev1, Eric Hager1
1Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania - USA.
Insights
Cephalic vein transposition effectively treats stenosis in the cephalic arch, a common issue for hemodialysis access. This safe procedure offers high patency rates, minimizing the need for further interventions.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access Management
Background:
- Stenosis of the cephalic arch, where the cephalic vein enters the axillary vein, is a frequent complication in upper extremity arteriovenous fistulas used for hemodialysis.
- Refractory cephalic arch stenosis can compromise hemodialysis access, necessitating effective treatment strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of cephalic vein transposition for managing refractory cephalic arch stenosis.
- To determine the long-term patency and re-intervention rates following cephalic vein transposition in hemodialysis patients.
Main Methods:
- A retrospective review was conducted on 23 patients who underwent cephalic vein transposition for cephalic arch stenosis between January 2008 and August 2015.
- Data collected included patient demographics, medical and access history, procedural details, access patency, and subsequent interventions.
Main Results:
- Cephalic vein transposition demonstrated a low complication rate (8.7%) with no need for temporary dialysis catheters.
- The re-intervention rate was low at 0.2 interventions per patient per year.
- Two-year primary patency was 70.9%, and cumulative patency was 94.7%.
Conclusions:
- Cephalic vein transposition is a safe and effective treatment for cephalic arch stenosis, allowing continued use of the hemodialysis access.
- This surgical approach is effective for isolated, refractory cephalic arch stenosis in mature arteriovenous fistulas, requiring minimal re-interventions.
Introduction:
The proximal cephalic vein that enters the axillary vein (cephalic arch) is a common site of stenosis in patients with upper extremity arteriovenous fistulas for hemodialysis (HD). In this study, we present the outcomes of a series of cephalic vein transposition, to determine its utility in the setting of refractory arch stenosis.
Methods:
We conducted a retrospective review of patients undergoing cephalic vein transposition to manage refractory cephalic arch stenosis from January 1, 2008 to August 31, 2015. Demographics, past medical history, access history of the patients as well as procedural details of the surgery to the stenotic segment, patency of the access, and the need for subsequent interventions were recorded.
Results:
Twenty-three patients underwent a cephalic vein transposition during the study period. The patients undergoing cephalic transposition had their current access for an average of 3.0 ± 2.6 years and had an average of 2.3 ± 0.9 interventions on the access prior to the surgery. Complications from the surgery were uncommon (8.7%) and no patient required a temporary tunneled dialysis catheter. The re-intervention rate was 0.2 ± 0.2 interventions per patient per year. At two years, primary patency was 70.9% and cumulative patency was 94.7% for the patients with cephalic transposition.
Conclusions:
Cephalic vein transposition is safe and effective treatment for cephalic arch stenosis without interrupting utilization of the access. The surgical approach to stenosis of the proximal cephalic vein is effective, requires minimal re-interventions, and should be considered for isolated, refractory cephalic arch stenosis in mature arteriovenous fistulas.
