Balloon assisted stent deployment in the cephalic arch (BASCA)

Abstract

Cephalic arch stenosis causes repeated dysfunction and failure of arteriovenous access. Outcomes following balloon angioplasty alone in this location are unsatisfactory. Stent grafts have very good patency rates in this location. However, stent graft placement is technically challenging in this location due to the adverse angles and vectors of the cephalic arch. Stent graft deployment in this location is associated with a real risk of jailing the axillary vein, thereby precluding the use of that arm for future accesses and/or predisposes to venous edema. We describe a technique that was used to safely and effectively deploy a stent graft in the cephalic arch of a 65-year-old male patient.

Letter to the Editor Regarding “First Clinical Results of the Merit WRAPSODY Cell-Impermeable Endoprosthesis for Treatment of Access Circuit Stenosis in Haemodialysis Patients” published by Gilbert et al

“…These images demonstrate stent-graft deployment in the cephalic vein, extending to the mid-subclavian vein and, thus, jailing the axillary venous confluence. While this is a known complication of stent graft use in the cephalic vein [2], there are sufficient techniques described for the experienced interventionalist to mitigate this risk [3,4]. In the case illustration provided in this article, although the stent-graft resolved the stenosis and the final images demonstrated inline flow from the cephalic vein to the right atrium, exclusion of the axillary vein by a covered stent obstructs the basilic and brachial venous inflow.…”