Purpose: Cephalic arch stenosis is a known cause of hemodialysis access failure in patients with brachiocephalic fistulas (BCFs). Outcomes of endovascular treatment are affected by resistance of the stenosis to balloon dilation, a high vein rupture rate and the development of early restenosis. The purpose of this retrospective study was to report outcomes after cutting balloon angioplasty (CBA) of cephalic arch stenosis.
Methods: In our vascular access database we identified 74 dysfunctional BCFs of which 30 (41%) were caused by cephalic arch stenosis. Seventeen fistulas in 17 patients (13 males and four females; median age 62 yrs; range 52-86) were treated with CBA (June 2005 to January 2008). Twenty-five procedures were performed. In 15 procedures, a cutting balloon was used alone and in 10 procedures CBA was followed by standard or high-pressure balloon angioplasty. Restenosis rates were calculated and patency rates were estimated with the Kaplan-Meier method.
Results: Primary patency rates (+/-SEE) at 3, 6, 12 and 15 months were 94% (+/-6%), 81% (+/-10%), 38% (+/-14%) and 22% (+/-15%), respectively. Assisted primary patency rates (+/-SEE) at the same intervals were 100% (+/-0%), 94% (+/-6%), 77% (+/-12%) and 63% (+/-13%), respectively. The mean interval between radiological interventions was 13 months (SD=8) and the mean number of interventions required per patient-year of dialysis was 0.9.
Conclusion: Treatment of cephalic arch stenosis with CBA did not improve patency compared to published results of conventional PTA, but our results indicate that CBA may lower the frequency of required re-interventions.