Background: Recurrent cephalic arch stenosis (CAS) has been linked to high flow and has a high rate of recurrence following angioplasty. This study investigates the effectiveness of access flow reduction in decreasing rapidly recurrent symptomatic CAS.
Methods: A retrospective study of patient records from February 2005 to April 2009 was conducted. Patients with brachiocephalic fistulas who had undergone two or more instances of cephalic arch angioplasty within 3 months, and thereafter underwent flow reduction via banding of the access inflow (n=33) were included. A before-and-after analysis was conducted: the rates of cephalic arch angioplasty were calculated for each patient before and after the banding procedure, and compared via a paired t-test.
Results: At 3, 6, and 12 months, the cephalic arch primary lesion patency was 91%, 76%, and 57%. The cephalic arch intervention rate was reduced from 3.34 to 0.9 per access-year (t=7.74, p<.001). The average follow-up time was 14.5 months (range, 4.8-32).
Conclusion: Flow reduction of a brachiocephalic arteriovenous hemodialysis fistula may effectively diminish the incidence of symptomatic CAS.
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View Article and Find Full Text PDFArticle Synopsis
- The study investigated risk factors for central vein stenosis (CVS) in hemodialysis patients who had normal preoperative venography.
- Out of 349 patients who underwent arteriovenous fistula creation, 22 (6.3%) developed CVS during an average follow-up of 20.9 months.
- Key independent risk factors identified included having two or more collateral vessels on venography, the creation of a left-sided arteriovenous fistula, and a history of ipsilateral hemodialysis catheter placement.
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