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Stent Diameter, Not Cephalic Arch Anatomy, Predicts Stent Graft Patency in Cephalic Arch Stenosis
Alexis M Cahalane1, Salim E Abboud2, Tatsuo Kawai3
1Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Insights
Stent graft placement for cephalic arch stenosis in arteriovenous fistulae shows higher patency rates than angioplasty alone. Optimal stent graft diameter is crucial for maintaining long-term patency.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Cephalic arch stenosis (CAS) is a common complication affecting arteriovenous fistulae (AVFs) used for hemodialysis access.
- Stent graft (SG) placement is an option for treating CAS, but its effectiveness compared to percutaneous transluminal angioplasty (PTA) requires further investigation.
- Understanding factors influencing AVF patency after intervention is critical for optimizing dialysis access outcomes.
Purpose of the Study:
- To evaluate the relationship between anatomical factors and the primary patency of brachiocephalic AVFs following SG placement for CAS.
- To compare the primary patency rates of CAS treated with SG placement versus PTA alone.
Main Methods:
- A retrospective study included 63 patients who received SGs for CAS in brachiocephalic AVFs between 2014 and 2017.
- A control group of 31 patients treated with PTA only for CAS was also analyzed.
- Patient demographics, AVF anatomy, SG characteristics, and clinical outcomes were reviewed, with a mean follow-up of 1,994 days.
Main Results:
- Primary patency rates for CAS after SG placement were 64% at 6 months, 49.9% at 12 months, and 23.5% at 3 years.
- Primary patency was significantly associated with SG diameter (P = .007) but not with other anatomical factors.
- Patients treated with SG placement demonstrated significantly higher primary patency at 6 months (64% vs. 61%), 12 months (49.9% vs. 35%), and 3 years (23.5% vs. 0%) compared to PTA-only treatment (P = .01).
Conclusions:
- SG placement for CAS in brachiocephalic AVFs results in significantly higher primary patency compared to PTA-only treatment.
- The diameter of the stent graft is a significant predictor of primary cephalic arch patency after intervention.
Purpose:
To investigate the relationship between anatomic factors and primary patency of brachiocephalic arteriovenous fistulae (AVFs) after stent graft (SG) placement for cephalic arch stenosis (CAS).
Materials And Methods:
This retrospective study reviewed all cephalic arch SGs placed in brachiocephalic AVFs in a tertiary academic medical center between 2014 and 2017. Sixty-three patients were included in the study. The mean patient age at the time of SG placement was 62.6 years ± 19, and the mean patient follow-up was 1,994 days ± 353. A cohort of patients (n = 31) who underwent brachiocephalic fistulograms for CAS but only received percutaneous transluminal angioplasty (PTA) was the control group. Patient demographic characteristics, AVF anatomy, SG type, and clinical outcomes were reviewed. The duration of primary cephalic arch patency after SG placement was compared with that after previous PTA.
Results:
The median AVF age at the time of data retrieval was 345 days. The primary patency of CAS after SG placement at 6 months, 12 months, and 3 years was 64%, 49.9%, and 23.5%, respectively. Primary cephalic arch patency was significantly associated with the SG diameter (P = .007) but not with cephalic vein-axillary vein junction anatomy, size of feeding artery, or SG length (P > .05). The primary patency of CAS in patients treated with PTA only (n = 31) at 6 months, 12 months, and 3 years was 61%, 35%, and 0%, respectively, which was significantly lower than that in patients treated with SG placement (P = .01).
Conclusions:
This study showed that the primary patency of CAS after SG placement was significantly higher than that of PTA-only treatment. Moreover, primary cephalic arch patency after SG placement was significantly associated with the SG diameter.
