Challenges in Managing Cephalic Arch Stenosis: A Case of Stent Fracture and Lessons Learned

Cephalic arch stenosis (CAS) is a common cause of vascular access dysfunction in patients undergoing hemodialysis. This report describes a case of recurrent stent fractures and restenosis following endovascular treatment for CAS. A 34-year-old man with diabetic nephropathy and chronic hemodialysis underwent multiple stent placements for CAS. Complications, including stent entanglement during balloon angioplasty and stent fracture due to the cephalic arch's anatomical characteristics, necessitated surgical intervention. This case highlights two critical considerations: the unsuitability of balloon-expandable stents for CAS, as they lack resilience to deformation caused by shoulder movements, and the importance of selecting appropriate balloons to minimize stent damage. The unique anatomical characteristics of the cephalic arch increase the risk of stent bending and fracture, emphasizing the need for careful device selection. This case increases the awareness of stent placement for CAS.