Cephalic arch stenosis in autogenous haemodialysis fistulas: treatment with the viabahn stent-graft.
OBJECTIVE
Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS.


METHODS
Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up.


RESULTS
The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482-0.977] at 6 months and 72.7 % (95 % CI 0.390-0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587-0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156-2,282).


CONCLUSIONS
The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.
Radiology Department, The Royal London Hospital, London, UK. andrew.shawyer@bartsandthelondon.nhs.uk
Andrew
A
Shawyer
Nicos I
NI
Fotiadis
Girish
G
Namagondlu
Arun
A
Iyer
Mark
M
Blunden
Martin
M
Raftery
Magdi
M
Yaqoob
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011474:Prosthesis Design; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology