Surgical Management of Cephalic Arch Occlusive Lesions: Are There Predictors for Outcomes?
Article first published online: 4 MAR 2013
© 2013 Wiley Periodicals, Inc.
Seminars in Dialysis
Volume 26, Issue 4, pages E33–E41, July–August 2013
How to Cite
Wang, S., Almehmi, A. and Asif, A. (2013), Surgical Management of Cephalic Arch Occlusive Lesions: Are There Predictors for Outcomes?. Seminars in Dialysis, 26: E33–E41. doi: 10.1111/sdi.12085
- Issue published online: 17 JUL 2013
- Article first published online: 4 MAR 2013
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.