Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis

Abstract

The aim of this study is to appraise the current literature on the endovascular management options and their outcomes of cephalic arch stenosis in the setting of a failing brachiocephalic fistula for hemodialysis. Methods: A systematic search of the literature was performed using PubMed, Embase, and Google Scholar from January 2000 to December 2017 in accordance with the PRISMA guidelines to investigate the outcomes of endovascular management of cephalic arch stenosis. Data from randomized controlled trials and observational studies, published in the English language, were extracted to determine pooled proportion of primary and secondary patency, using a randomeffects meta-analysis. Subgroup analyses of stent grafts, bare metal stents, and percutaneous transluminal angioplasty outcomes were performed. Results: Of the 125 total studies, 11 were included for analysis by consensus. Overall, 457 patients were reviewed and analyzed for primary and secondary patency rates at 6 and 12 months post-treatment. There was significantly higher primary patency at both 6 and 12 months in the stent graft group compared to those who received bare metal stents or percutaneous transluminal angioplasty (relative risk = 0.30-0.31, relative risk = 0.34-0.59, respectively; p < 0.01). Higher secondary patency rates were noted in the bare metal stents cohort compared to the percutaneous transluminal angioplasty cohort at 12 months (relative risk = 0.17, 95% confidence interval = 0.07-0.26; p < 0.01). Conclusion: This study demonstrated a significant benefit in using stent grafts in cephalic arch stenosis compared to bare metal stents or percutaneous transluminal angioplasty with higher primary and secondary patency rates.

Undersized stent graft for treatment of cephalic arch stenosis in arteriovenous hemodialysis access

“…Treatment of CAS is further complicated by higher rupture rate due to increased pressure required for anatomical success. As venoplasty alone has not demonstrated significant lasting benefits for CAS, recent comparison has demonstrated superiority of SG over other modalities of endovascular treatment, specifically venoplasty, BMS and drug-eluting stent in the treatment of CAS, at maintaining CAS patency 7 .…”

“…As venoplasty alone has not demonstrated significant lasting benefits for CAS, bare-metal stent (BMS) placement and stent graft (SG) have been prescribed with better but still variable results. A recent 2 year comparison between venoplasty, placement of BMS and placement of SG, has shown primary patency of 23.3, 52.2 and 82.7% at 6 months and 9.5, 12.9 and 44% at 12 months, respectively 7 .…”

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). Despite appropriate sizing and accurate deployment of the Fluency SG, central stent migration may result in jailing of the axillary vein.…”

“…Stent-graft (SG) placement for cephalic arch stenosis in dysfunctional dialysis access is an option for patients, and a recent systematic review suggests that it may be more durable in the short term compared to angioplasty alone (Miller et al 2018;D'Cruz et al 2019). Precise placement of SGs in the cephalic arch, particularly the terminal segment near or at the junction with the axillary vein, can be difficult.…”

Managing Arrow-Trerotola Percutaneous Thrombolytic Device Complications

“…Currently, the authors would likely use a self-expanding stent graft, such as a Viabahn (W. L. Gore, Flagstaff, AZ), which has the additional advantage of improved patency rates in the cephalic arch compared with angioplasty or bare metal stents. [7][8][9][10][11] Given the IFU warning against using the PTD in stents, case reports of stent-related complications are predictably difficult to find in the literature. Recent stent placement, poor wall apposition (more likely in fistulae than in grafts), and bare metal construction could all plausibly contribute to increased likelihood of stent entanglement with the fragmentation basket.…”