Characterization of the Cephalic Arch and Location of Stenosis

Abstract

Purpose The purpose of this study is to accurately characterize the cephalic arch segments into four domains and to enable more specific evaluation of cephalic arch stenosis (CAS) and determine the frequency of stenosis in each domain. Methods After Institutional Review Board (IRB) approval, a retrospective chart review was done to define a population of patients receiving hemodialysis who developed CAS as apparent on clinically indicated radiologic imaging. A standardized approach was devised to categorize four domains of the cephalic arch. Domain I was defined as the peripheral portion of the arch and Domain IV was the distal portion of the cephalic vein near termination with the axillary vein. The magnitude of stenosis as measured by percentage was determined and compared in the four domains. Results The most frequent location for stenosis was found in domain IV when compared with domains II or I (p<0.01). The magnitude of stenosis differed across all domains (p<0.001) with the least common place for CAS in domain I. Treatment of CAS included angioplasty in all, thrombectomy in eight, and stent placement in five. Conclusions CAS occurs most commonly in the terminal portion of the arch. Four standardized domains have been defined; future work will validate these findings and determine the best intervention for each domain.

Increased Inlet Blood Flow Velocity Predicts Low Wall Shear Stress in the Cephalic Arch of Patients with Brachiocephalic Fistula Access

“…Primary brachiocephalic fistulae (BCF) for hemodialysis frequently lose patency because stenosis occurs in the cephalic arch, a vein segment that connects the cephalic to the axillary vein [ 1 , 2 ]. Stenosis is commonly ascribed to an increased blood flow rate, external musculoskeletal compression, or hypertrophy of valves [ 3 , 4 ].…”

Recanalisation of an axillary vein occlusion jailed by a migrated cephalic arch stent-graft using the TruePath chronic total occlusion drilling device

“…Cephalic arch stenosis affects up to 34% of dysfunctional brachiocephalic AVFs (Bennett et al 2015). The use of stents, in particular SGs, to treat recurrent cephalic arch stenosis has been increasing due to low primary patency rates of balloon angioplasty and an increasing body of evidence demonstrating superior patency rates of stents (Miller et al 2018;D'Cruz et al 2019).…”

A rare anatomic variant of a single-conduit supraclavicular cephalic arch draining into the external jugular vein presenting with recurrent arteriovenous fistula stenosis in a hemodialysis patient

“…Trifid circulations with complex collaterals have also been discovered. 3 Lau et al described a case of supraclavicular cephalic arch that drained into the subclavian vein during permanent pacemaker implantation. 4 Yeri et al described a cadaveric case of the cephalic vein joining the EJV, albeit taking an infraclavicular course.…”