Abstract
Aim
To conduct a systematic review of management of current cephalic arch stenosis (CAS) and associated outcomes in the context of dysfunctional hemodialysis access.
Materials and 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.
Conclusion
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.
Similar content being viewed by others
References
Badero OJ, Salifu MO, Wasse H, Work J. Frequency of swing-segment stenosis in referred dialysis patients with angiographically documented lesions. Am J Kidney Dis. 2008;51(1):93–8.
Hammes M, Funaki B, Coe FL. Cephalic arch stenosis in patients with fistula access for hemodialysis: relationship to diabetes and thrombosis. Hemodial Int. 2008;12(1):85–9.
Kian K, Unger SW, Mishler R, Schon D, Lenz O, Asif A. Role of surgical intervention for cephalic arch stenosis in the “fistula first” era. Semin Dial. 2008;21(1):93–6.
Miller GA, Friedman A, Khariton A, Preddie DC, Savransky Y. Access flow reduction and recurrent symptomatic cephalic arch stenosis in brachiocephalic hemodialysis arteriovenous fistulas. J Vasc Access. 2010;11(4):281–7.
Daoui R, Asif A. Cephalic arch stenosis: mechanisms and management strategies. Semin Nephrol. 2012;32(6):538–44.
Sivananthan G, Menashe L, Halin NJ. Cephalic arch stenosis in dialysis patients: review of clinical relevance, anatomy, current theories on etiology and management. J Vasc Access. 2014;15(3):157–62.
Rajan DK, Clark TWI, Patel NK, Stavropoulos SW, Simons ME. Prevalence and treatment of cephalic arch stenosis in dysfunctional autogenous hemodialysis fistulas. J Vasc Interv Radiol. 2003;14(5):567–73.
Wang S, Almehmi A, Asif A. Surgical management of cephalic arch occlusive lesions: are there predictors for outcomes? Semin Dial. 2013;26(4):E33–41.
Aitken EL, Jackson AJ, Hameed H, Chandramohan M, Kasthuri R, Kingsmore DB. Cephalic arch stenosis: angioplasty to preserve a brachiocephalic fistula or new brachiobasilic fistula?: a cost-effectiveness study. Ren Fail. 2014;36(10):1550–8.
Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603–10.
Gray RS, Sacks D, Martin LG, Trerotola SO, et al. Reporting standards for percutaneous interventions in dialysis access. J Vasc Interv Radiol. 2003;14:S433–42.
Heerwagen ST, Lönn L, Schroeder TV, Hansen MA. Cephalic arch stenosis in autogenous brachiocephalic hemodialysis fistulas: results of cutting balloon angioplasty. J Vasc Access. 2010;11(1):41–5.
Shemesh D, Goldin I, Zaghal I, Berlowitz D, Raveh D, Olsha O. Angioplasty with stent graft versus bare stent for recurrent cephalic arch stenosis in autogenous arteriovenous access for hemodialysis: a prospective randomized clinical trial. J Vasc Surg. 2008;48(6):1524–31.
Shawyer A, Fotiadis NI, Namagondlu G, et al. Cephalic arch stenosis in autogenous haemodialysis fistulas: treatment with the viabahn stent-graft. Cardiovasc Intervent Radiol. 2013;36(1):133–9.
Rajan DK, Bunston S, Misra S, Pinto R, Lok CE. Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty-are there clinical predictors of patency? Radiology. 2004;232(2):508–15.
Chen JC, Kamal DM, Jastrzebski J, et al. Venovenostomy for outflow venous obstruction in patients with upper extremity autogenous hemodialysis arteriovenous access. Ann Vasc Surg. 2005;19(5):629–35.
Kalman PG, Pope M, Bhola C, Richardson R, Sniderman KW. A practical approach to vascular access for hemodialysis and predictors of success. J Vasc Surg. 1999;30:727–33.
Sigala F, Saben R, Kontis E, et al. Surgical treatment of cephalic arch stenosis by central transposition of the cephalic vein. J Vasc Access. 2014;15(4):272–7.
Turmel-Rodrigues L, Pengloan J, Baudin S, et al. Treatment of stenosis and thrombosis in hemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant. 2000;15:2029–36.
Kian K, Unger SW, Mishler R, Schon D, Lenz O, Asif A. Cephalic arch stenosis. Semin Dial. 2008;21(1):78–82.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.
Bennett S, Hammes MS, Blicharski T, Wilson S, Funak B. Characterization of the cephalic arch and location of stenosis. J Vasc Access. 2014; doi:10.5301/jva.5000291.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
No conflicts of interest are disclosed by any of the authors of this manuscript.
Ethical Approval
For this type of study, formal consent is not required.
Informed Consent
Does not apply.
Rights and permissions
About this article
Cite this article
Vasanthamohan, L., Gopee-Ramanan, P. & Athreya, S. The Management of Cephalic Arch Stenosis in Arteriovenous Fistulas for Hemodialysis: A Systematic Review. Cardiovasc Intervent Radiol 38, 1179–1185 (2015). https://doi.org/10.1007/s00270-015-1190-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-015-1190-4