title: Surgical management of cephalic arch occlusive lesions: are there predictors for outcomes?
abstract: Cephalic arch lesions are common cause for dysfunction of brachiocephalic arteriovenous fistulas. For lesions resistant or not amenable to endovascular interventions, we used a term "cephalic arch occlusive lesions" (CAO) that included cephalic arch total occlusion, frequently recurrent stenosis (requiring angioplasty in <3-month intervals), high-grade elastic stenosis (residual stenosis >50% after angioplasty), or other lesions not amenable to endovascular interventions. Herein, we report 40 patients who underwent surgical revisions for total occlusions (17/40), frequently recurrent stenosis (17/40), high-grade elastic stenosis (5/40), and zigzag stenosis (1/40). The revisions included cephalic transposition and venovenostomy (CTV = 37/40), basilic transposition and venovenostomy (1/40), stenotic segment resection (1/40), and cephalic-jugular vein bypass graft (1/40). At 12-month post-CTV, the primary patency of the transposed cephalic vein, the fistula assisted primary and secondary patency rates were 25%, 82% and 97%, respectively. Notably, pre-CTV angioplasty of the proximal cephalic vein was the only significant predictor for the low primary patency rate (hazard ratio 4.5, p = 0.002). Accordingly, the primary patency rates were 12% and 58% in patients with and without pre-CTV angioplasty, respectively. In summary, surgical interventions are effective in salvaging fistulas complicated with CAO. Importantly, pre-CTV angioplasty of the proximal cephalic vein might adversely affect the outcome of CTV.
authors: AKDHC-ASC, Arizona Kidney Disease and Hypertension Center, Phoenix, AZ 85012, USA. swang@akdhc.com
authors: Shouwen
authors: S
authors: Wang
authors: Ammar
authors: A
authors: Almehmi
authors: Arif
authors: A
authors: Asif
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology