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Updated: Feb 7, 2026

Fabrication of Small Caliber Stent-grafts Using Electrospinning and Balloon Expandable Bare Metal Stents
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Recurrent cephalic arch stent graft twisting salvaged by bare metal stents reinforcement

Jacky Siu Chung Tam1, Laurence Tsz Him Pang2, Tommy Ho Fung Chan3

  • 1Division of Vascular Surgery, Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR.

The Journal of Vascular Access
|February 6, 2026
PubMed

Insights

Cephalic arch stenosis (CAS) in arteriovenous fistulas (AVFs) can cause dysfunction. A stent graft twist, a complication of CAS treatment, was successfully resolved using additional venous bare stents.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Nephrology

Background:

  • Cephalic arch stenosis (CAS) frequently causes arteriovenous fistula (AVF) dysfunction, necessitating interventions.
  • Angioplasty for CAS has a high restenosis rate, leading to increased reinterventions.
  • Stent grafts offer improved patency but can present unique complications.

Purpose of the Study:

  • To report a case of recurrent CAS dysfunction after stent graft placement.
  • To describe an endovascular solution for stent graft twisting in CAS.
  • To postulate underlying reasons for stent graft twisting in CAS.

Main Methods:

  • A 65-year-old female patient with end-stage renal failure and a right brachiocephalic AVF presented with recurrent CAS.
  • Initial treatment involved multiple angioplasties, followed by stent graft deployment.
  • Stent graft twisting was managed with additional venous bare stents for mechanical support.

Main Results:

  • The patient experienced recurrent AVF dysfunction due to cephalic arch stent graft twisting.
  • Successful resolution of the twist and restoration of AVF function were achieved with additional venous bare stents.
  • The intervention provided mechanical support, preventing further twisting and dysfunction.

Conclusions:

  • Stent graft twisting is a potential complication in treating CAS.
  • Additional venous bare stents can effectively resolve stent graft twisting and restore AVF function.
  • Understanding the etiology of twisting may inform future treatment strategies for CAS.

Keywords:
Cephalic arch stenosisCoverastent collapsestent graftstent twisting

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