Access flow reduction and recurrent symptomatic cephalic arch stenosis in brachiocephalic hemodialysis arteriovenous fistulas.
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).


CONCLUSIONS
Flow reduction of a brachiocephalic arteriovenous hemodialysis fistula may effectively diminish the incidence of symptomatic CAS.
Miller
Gregg Arthur
GA
American Access Care of Brooklyn, NY 11215, USA. vascular1@att.net
Friedman
Alexander
A
Khariton
Aleksandr
A
Preddie
Dean C
DC
Savransky
Yevgeny
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009518:New York; D011859:Radiography; D012008:Recurrence; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency