title: The Management of Cephalic Arch Stenosis in Arteriovenous Fistulas for Hemodialysis: A Systematic Review.
abstract: OBJECTIVE
  To conduct a systematic review of management of current cephalic arch stenosis (CAS) and associated outcomes in the context of dysfunctional hemodialysis access.
  
  
  METHODS
  PubMed, Web of Science, and Cochrane Library were searched to retrieve literature on the management of CAS. Studies had to focus on management of access stenosis solely in the cephalic arch. Case reports and literature reviews were excluded. Studies were categorized by intervention, and primary and secondary patency data were compiled. Studies were aggregated, and meta-analyses were performed where possible.
  
  
  RESULTS
  Nine papers satisfied the aforementioned criteria: five were retrospective studies and four were prospective studies. CAS management strategies have included percutaneous transluminal balloon angioplasty (PTA), peripheral cutting balloons, surgical cephalic vein transpositions, bare stents, and stent grafts. Reporting strategies varied between studies. Meta-analyses showed that results were variable even within studies using the same modality, particularly for PTA.
  
  
  CONCLUSIONS
  No singular, definitive management strategy exists for CAS. Current studies are limited by being primarily single-center retrospective trials featuring heterogenous patient populations, interventions, and endpoints. Priorities for future studies should include larger randomized trials, more uniform management strategies and endpoints, and a longer duration of follow-up.
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. lakshman.vasanthamohan@medportal.ca.
authors.forename: Lakshman
authors.initials: L
authors.lastname: Vasanthamohan
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. Prasa.gopee@medportal.ca.
authors.forename: Prasaanthan
authors.initials: P
authors.lastname: Gopee-Ramanan
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. sathreya@stjoes.ca.|Lead Interventional Radiologist, Centre for Interventional Radiology and Oncology (CIRO), St. Joseph's Healthcare Hamilton, 50 Charlton Ave. E., Rm. T0112, Hamilton, ON, L8N 4A6, Canada. sathreya@stjoes.ca.
authors.forename: Sriharsha
authors.initials: S
authors.lastname: Athreya
mesh_terms: D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016121:Brachiocephalic Veins / Q000473:pathology*; D003251:Constriction, Pathologic; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D006435:Renal Dialysis; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000628:therapy*
keywords: Angioplasty/angiogram; Arterial intervention; Arteriovenous fistulas; End stage renal disease; Hemodialysis; Venous intervention