Predictive factors of recurrent endovascular intervention for cephalic arch stenosis after percutaneous transluminal angioplasty

Neves, Marta; Outerelo, Cristina; Pereira, Marta; Neves, Fernando; Carvalho, Telmo; Maia, Pedro; Ponce, Pedro

doi:10.1016/j.jvs.2017.12.055

Cited by 10 publications

(14 citation statements)

References 21 publications

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“…19,20 On the other hand, an isolated CAS lesion as compared to multiple lesions within the cephalic arch, and the presence of diabetes were negatively associated with recurrent CAS. 19,21 It is well recognized that both anatomical and hemodynamic factors contribute to the development of CAS. Along the course of the cephalic vein's passage in the deltopectoral groove, it narrows as it approaches its junction with the central veins, giving rise to the characteristic arch structure in which high blood flow generated by fistula formation engenders turbulence and shear stress.…”

Section: Discussionmentioning

confidence: 97%

“…Studies revealed that CAS occurred more often in BCFs than in RCFs due to high blood flow flowing cephalic arch in BCFs, and severity of stenosis (%) at index visit and residual stenosis (%) after PTA were deemed predictive of its recurrence. 19,20 On the other hand, an isolated CAS lesion as compared to multiple lesions within the cephalic arch, and the presence of diabetes were negatively associated with recurrent CAS. 19,21…”

Section: Discussionmentioning

confidence: 98%

“…19,20 On the other hand, an isolated CAS lesion as compared to multiple lesions within the cephalic arch, and the presence of diabetes were negatively associated with recurrent CAS. 19,21…”

Section: Discussionmentioning

confidence: 98%

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Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate

Kim

Chung

et al. 2021

J Vasc Access

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Objective: Despite the widespread use of conventional percutaneous transluminal angioplasty (PTA), recurrence of cephalic arch stenosis (CAS), and low patency rate after PTA remain challenging problem. We aimed to identify the clinical predictors of recurrence of CAS and evaluate the effect of the access flow reduction on the fistula patency rate in patients with recurrent CAS. Methods: In 1118 angiographies of 220 patients with CAS, access circuit patency rates after PTA and potential clinical predictors of recurrence of CAS were assessed. The effect of the banding procedure was evaluated in terms of post-interventional primary patency rate, and the number of interventions per access-year. Results: At 3, 6, and 12 months after the first PTA on CAS, the post-interventional access circuit primary patency rates were 68.8%, 40.5%, and 25.1%, respectively. High CV to CA ratio (the ratio of the maximal diameter of the distal cephalic vein to the diameter of the cephalic arch) (Hazard ratio (HR), 1.437; 95% confidence interval (CI), 1.036–1.992) and involvement of the proximal segment of cephalic arch (HR, 1.828; 95% CI, 1.194–2.801) were significant predictors of recurrent CAS. For those with recurrent CAS (>3 times/year) and an access flow rate >1.5 L/minute, endovascular banding procedure was performed. The banding procedure significantly reduced the number of interventions per access-year ( t = 3.299, p = 0.005 and t = 2.989, p = 0.007, respectively). Post-interventional access circuit primary patency rate after banding was significantly higher than that before banding ( p = 0.01). Conclusions: High CV to CA ratio and involvement of the proximal segment of the cephalic arch are independent clinical predictors of recurrent CAS. Endovascular banding might delay recurrence of CAS in patients with high CV to CA ratio and high access flow.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

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Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate

Kim

Chung

et al. 2021

J Vasc Access

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“…They proposed that these geometrical changes were caused by hemodynamic differences in diabetics such as higher arterial pressures and blood flow velocities combined with narrower diameter vessels with calcifications 42 . A different study by Neves et al identified that diabetes was a risk factor for recurrent CAS after percutaneous intervention, but the authors were not able to pinpoint the exact reason for this finding 43 …”

Section: Cephalic Arch Stenosis (Cas)mentioning

confidence: 99%

“…42 A different study by Neves et al identified that diabetes was a risk factor for recurrent CAS after percutaneous intervention, but the authors were not able to pinpoint the exact reason for this finding. 43…”

Section: Etiologymentioning

confidence: 99%

Swing segment stenosis: An unresolved challenge

Gunawardena

Ridgway

2022

Seminars in Dialysis

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The native arteriovenous fistula is considered the gold standard among all dialysis access options. Compared with alternatives such as grafts and central venous catheters, their use is associated with a lower risk of infective and thrombotic complications. This leads to better patient outcomes and reduced healthcare-associated costs.Recognizing these advantages, there is a global drive to increase the creation and use of such fistulas in hemodialysis patients. Swing segment stenosis is a common problem encountered with the creation and use of these fistulas that can hurt their maturation and longevity. A "swing segment" in an arteriovenous fistula is defined as a segment of vein that pursues a sharp, curved course. Due to poorly understood reasons, these swing segments tend to develop stenotic lesions that are extremely challenging to treat. This review aims to provide an overview of the pathophysiology, incidence, management, and prevention of these swing segment lesions. We believe that such knowledge will be useful for clinicians who deal with dialysis access creation and maintenance. | INTRODUCTIONThe native arteriovenous fistula (AVF) is considered the vascular access of choice for those who require long-term hemodialysis (HD). This is due to their superior long-term patency and lower complication rates compared with arteriovenous grafts (AVGs) and central venous catheters (CVCs). 1 Additionally, those who are dialyzed through AVFs enjoy better survival compared with those who use AVGs or CVCs. 2 Considering these advantages, the fistula first initiative was launched in 2003, to increase the use of AVFs for HD in 50% of new patients and 40% of current patients. Later, these goals were modified to achieve a 65% AVF use in current HD patients. 3 As the global emphasis on the creation and use of AVFs increased, issues with regard to their maturation and patency became more pertinent. Swing segment stenosis is one such common problem that can affect successful fistula maturation and longevity. 4 A mature AVF is characterized by a diameter of >5 mm and a flow rate of ≥500 ml/min. A successful native AVF is expected to reach these parameters after 4-8 weeks from its creation. 5 Up to 60% of AVFs may not achieve these targets, and swing segment stenosis has been identified as a leading cause for this problem. 6 According to some investigators, swing segment lesions were the commonest reason for AVF dysfunction. 7 A "swing segment" in an AVF is defined as a segment of the vein that follows a sharp, curved course. This segment can be located in the vein that comprises the fistula or in its natural drainage pathway. 5 Swing segments are created adjacent to the anastomosis in radiocephalic (RC), brachio-cephalic (BC), and brachio-basilic (BB) fistulas as a result of surgical mobilization of the vein. These juxta-anastomotic swing segments are termed "distal" swing segments (Figure 1A). A "proximal" swing segment is generated close to the axilla when the basilic vein is transposed in a BB AVF (Figure 1B). A "natural" sw...

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Swing Point Stenosis

Beathard

2021

Dialysis Access Management

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Predictive factors of recurrent endovascular intervention for cephalic arch stenosis after percutaneous transluminal angioplasty

Abstract: Multivariate analysis showed that diabetes and residual stenosis (albeit <30%) were predictive of recurrence, whereas the finding of an isolated CAS lesion as opposed to stenoses in multiple locations was shown to be negatively associated with recurrent CAS, appearing to be "protective".

Cited by 10 publications

References 21 publications

Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate

Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate

Swing segment stenosis: An unresolved challenge

Swing Point Stenosis

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