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Management of cephalic arch stenosis in hemodialysis access: Updated systematic review and meta-analysis

Hyangkyoung Kim1, Young Shin Kim2, Nicos Labropoulos3

  • 1Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea.

The Journal of Vascular Access
|August 4, 2024
PubMed

Insights

Cephalic arch stenosis (CAS) treatment outcomes were assessed. Surgical transposition (STG) showed superior primary patency compared to other methods, suggesting it as a potential primary treatment option.

Area of Science:

  • Vascular Surgery
  • Interventional Nephrology
  • Medical Technology Assessment

Background:

  • Cephalic arch stenosis (CAS) is a recurrent complication in hemodialysis access, often resistant to treatment.
  • Current treatment outcomes for CAS are not well-validated, necessitating further clinical assessment.

Purpose of the Study:

  • To evaluate the clinical outcomes of various treatments for cephalic arch stenosis (CAS) in patients undergoing hemodialysis access.
  • To compare the efficacy of different treatment modalities for CAS through meta-analysis.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs were conducted, searching electronic databases up to December 4, 2023.
  • Network meta-analyses (NMA) were employed to compare odds ratios (OR) and cumulative ranking curves across different treatment modalities.
  • The review adhered to PRISMA-P guidelines and is registered in PROSPERO (CRD42022296513).

Main Results:

  • The analysis included 4 RCTs and 15 non-RCTs, with significant heterogeneity observed in fistula type and patient conditions.
  • No significant difference in primary patency was found between drug-coated balloons (DCB) and percutaneous transluminal angioplasty (PTA) at 6 and 12 months (low certainty evidence).
  • Surgical transposition (STG) demonstrated favorable results compared to stents or PTA at 3, 6, and 12 months, with primary patency rankings at 12 months: STG (92.7%), transposition (76.0%), stent (67.5%), PTA (64.5%), and DCB (46.3%).

Conclusions:

  • Despite data limitations and low-certainty evidence, STG may be a preferred primary treatment for CAS when applicable.
  • STG shows potential for superior primary patency and higher treatment ranking compared to other interventions for CAS.
  • Further research is needed to solidify evidence on CAS treatment efficacy.
Abstract

Keywords:
Arteriovenous shuntangioplastyballoonbiocompatiblecoated materialsstentssurgicalvascular patency

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