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Outcomes of Cephalic Arch Stenosis With and Without Stent Placement after Percutaneous Balloon Angioplasty in Hemodialysis Patients
Author(s) -
Dukkipati Ramanath,
Lee Luani,
Atray Naveen,
Kajani Raahil,
Nassar George,
KalantarZadeh Kamyar
Publication year - 2014
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12310
Subject(s) - medicine , balloon , angioplasty , hemodialysis , stenosis , stent , arch , hemodialysis access , percutaneous , surgery , radiology , vascular access , civil engineering , engineering
Cephalic arch stenosis is a common complication in maintenance hemodialysis ( MHD ) patients with brachial artery‐cephalic vein fistulas and frequently leads to loss of the functioning brachial artery‐cephalic vein fistula. There is paucity of conclusive data to guide appropriate management. We examined the risk of recurrence of cephalic arch stenosis after angioplasty compared to angioplasty after stent placement determined by angiography of the involved upper extremity over time in a contemporary cohort of MHD patients treated in two interventional nephrology practices from March 2008 through May 2011. We retrospectively identified 45 MHD patients with evidence of cephalic arch stenosis (age 60 ± 30 years, 45% men) on elective angiograms. The median number of days until another angioplasty was required decreased, starting with a median of 91.5 days after the first, 70.5 days after the second, 85 days after the third, and 56 days after the fourth. Angioplasty is associated with a faster rate of recurrence of cephalic arch stenosis. The placement of intravascular stent seems to prolong the patency compared to angioplasty alone. Clinical trials with a larger sample size will better elucidate the value and timing of angioplasty versus stent placement in cephalic arch stenosis.