Cephalic arch stenosis: An analysis of outcome by type of first intervention

Pisano, U., Stevenson, K., Kasthuri, R. and Kingsmore, D. (2024) Cephalic arch stenosis: An analysis of outcome by type of first intervention. CVIR Endovascular, 7, 13. (doi: 10.1186/s42155-023-00424-4) (PMID:38240913) (PMCID:PMC10798936)

Abstract

Background Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS. Methods Retrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via χ2 or Fisher’s; nonparametric tests used for skewed data. Kaplan–Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP. Results One hundred one brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%, p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01). Conclusions SG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity.

• Item Type: Articles
• Additional Information: The work was supported by the Endowment Fund of the Interventional Radiology Department of NHS Greater Glasgow and Clyde.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kingsmore, Prof David and Pisano, Dr Umberto and Kasthuri, Dr Ram and Stevenson, Dr Karen
• Authors: Pisano, U., Stevenson, K., Kasthuri, R., and Kingsmore, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: CVIR Endovascular
• Publisher: Springer
• ISSN: 2520-8934
• ISSN (Online): 2520-8934
• Copyright Holders: Copyright: © The Author(s) 2024
• First Published: First published in CVIR Endovascular 7: 13
• Publisher Policy: Reproduced under a Creative Commons licence