Outcomes of intervention for cephalic arch stenosis in brachiocephalic arteriovenous fistulas

Hicks, Taylor D.; Haidar, George M.; El-Sayed, Hosam F.

doi:10.1016/j.jvs.2017.05.116

Cited by 29 publications

(32 citation statements)

References 25 publications

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“…The latter is associated with lower morbidity and mortality as well as faster recovery, which is especially important in end-stage renal disease (ESRD) patients with multiple comorbidities. 3) Various endovascular techniques have been described, including catheter-directed thrombolysis (CDT) and mechanical thrombectomy. Such techniques are often employed in conjunction with treating the underlying pathology, usually stenosis, by balloon angioplasty.…”

Section: Introductionmentioning

confidence: 99%

The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts

HUAN

Tan

Chua

et al. 2020

Annals of Vascular Diseases

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Objective: This paper documents our experience using the Cleaner XT device (Argon Medical Devices, Plano, TX, USA) for pharmacomechanical thrombolysis (PMT) of thrombosed haemodialysis arteriovenous grafts (AVG) and fistulas (AVF). Materials and Methods: This was a retrospective case series (n=17) over six months at Singapore General Hospital. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. Results: There were 8 (47%) males and the patients mean age was 66 (± 5.7) years. The mean age of AVF/AVG was 1605 (± 1099) days. All procedures were performed under local anaesthetic. PMT was performed within a mean time of 40 (±34.3) hours from the presentation. Technical, clinical and procedural success was 15/17 (88%). The thrombolysis agents used were tissue plasminogen activator (52.9%) and urokinase (41.2%). Mean primary patency time was 114 (± 116) days, with a 65% 1-month and 47% 3-month primary patency rates. The mean secondary patency time was 155 (±132) days, with 76% one-month and 65% threemonth secondary patency rates, respectively. AVF rupture occurred in 3/17 (18%) cases but did not involve loss of the access circuit. Conclusion: The Cleaner XT device is a safe, minimally invasive endovascular tool for PMT in thrombosed AVF/AVG, with relatively high success and low complication rates.

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Section: Introductionmentioning

confidence: 99%

The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts

HUAN

Tan

Chua

et al. 2020

Annals of Vascular Diseases

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“…10 Surgical intervention for CAS is usually offered to younger and healthier patients and have resulted in superior patency and functional outcomes. 8,9 Percutaneous transluminal angioplasty (PTA) may be associated with technical failure (24%), and rupture of the arch vein has been reported with an incidence of 6%, respectively. 5 PTA is associated with very low primary patency rates of 42% and 23% at 6 and 12 months, respectively, 11 while bare metal stents (BMS) fare equally poorly, with a reported primary patency of 39% and 0% at these same time points.…”

Section: Introductionmentioning

confidence: 99%

“…It is believed that the latter is usually associated with lower morbidity and mortality as well as quicker recovery and this is especially important in ESRF patients with multiple co-morbidties. 8 Furthermore, patients may also resume dialysis immediately after endo-vascular intervention, which may not necessarily be possible after surgical revision.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis

et al. 2018

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The aim of this study is to appraise the current literature on the endovascular management options and their outcomes of cephalic arch stenosis in the setting of a failing brachiocephalic fistula for hemodialysis. Methods: A systematic search of the literature was performed using PubMed, Embase, and Google Scholar from January 2000 to December 2017 in accordance with the PRISMA guidelines to investigate the outcomes of endovascular management of cephalic arch stenosis. Data from randomized controlled trials and observational studies, published in the English language, were extracted to determine pooled proportion of primary and secondary patency, using a randomeffects meta-analysis. Subgroup analyses of stent grafts, bare metal stents, and percutaneous transluminal angioplasty outcomes were performed. Results: Of the 125 total studies, 11 were included for analysis by consensus. Overall, 457 patients were reviewed and analyzed for primary and secondary patency rates at 6 and 12 months post-treatment. There was significantly higher primary patency at both 6 and 12 months in the stent graft group compared to those who received bare metal stents or percutaneous transluminal angioplasty (relative risk = 0.30-0.31, relative risk = 0.34-0.59, respectively; p < 0.01). Higher secondary patency rates were noted in the bare metal stents cohort compared to the percutaneous transluminal angioplasty cohort at 12 months (relative risk = 0.17, 95% confidence interval = 0.07-0.26; p < 0.01). Conclusion: This study demonstrated a significant benefit in using stent grafts in cephalic arch stenosis compared to bare metal stents or percutaneous transluminal angioplasty with higher primary and secondary patency rates.

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“…It is believed that this strategy is associated with lower morbidity and mortality as well as quicker recovery, especially important in ESRF patients with multiple comorbidities. 7 The SUPERA™ peripheral stent (Abbott Vascular, Santa Clara, CA, USA) is a self -expanding stent and has a high degree of flexibility and resistance to external compression compared with traditional laser-cut nitinol stents. 8 In particular, it maintains the round open lumen in challenging anatomies, such as in the popliteal artery.…”

Section: Introductionmentioning

confidence: 99%

Helical stent (SUPERA™) and drug-coated balloon (Passeo–18 Lux™) for recurrent cephalic arch stenosis: Rationale and design of arch V SUPERA–LUX Study

et al. 2019

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Background: The treatment options for cephalic arch stenosis are limited and standard of care remains at crossroads – none are ideal and there is currently no gold standard. Endovascular techniques are now the preferred primary therapeutic option because they are minimally invasive and better tolerated by haemodialysis patients who have multiple comorbidities. However, conventional plain old balloon angioplasty, bare metal stenting and stent grafts all have their limitations. The aim of this trial is to evaluate whether the helical SUPERA™ stent (Abbott Vascular, Santa Clara, CA, USA), which has a higher degree of flexibility and resistance to compressive forces compared to traditionally laser-cut nitinol stents, combined with a drug-coated balloon (Biotronik Passeo-18 Lux™) to minimize the neointimal hyperplasia effect, can improve patency and reduce reintervention rates. Methods and results: Arch V SUPERA-LUX is a pilot investigator-initiated single-centre, single-arm prospective study. Twenty patients with a brachiocephalic fistula within 6 months of initial plain old balloon angioplasty for significant cephalic arch stenosis will be recruited for treatment with SUPERA and drug-coated balloon. The primary objectives are immediate angiographic and procedural success, primary patency and functional fistula at 1 week, 8 weeks, 6 and 12 months. The results from eight patients treated prospectively as proof of concept have shown primary patency of 83.3% at 1 year with 100% technical and procedural success rates. Enrolment for the Arch V SUPERA-LUX study is expected to be completed at the end of 2019. Conclusion: The Arch V SUPERA-LUX study is the first trial to evaluate whether SUPERA stent implantation and drug-coated balloon use can provide superior protection against restenosis compared to traditional angioplasty, bare metal stents and stent grafts in recurrent cephalic arch stenosis. Initial pilot results are encouraging but longer follow-up is required to truly test this technique. Trial registration: This study is registered on ClinicalTrials.gov NCT03891693.

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Outcomes of intervention for cephalic arch stenosis in brachiocephalic arteriovenous fistulas

Abstract: Cephalic arch stenosis is a significant cause of brachiocephalic AVF malfunction. Surgical options offer superior long-term patency and functional results and should be considered earlier in the treatment of this disease.

Cited by 29 publications

References 25 publications

The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts

The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts

Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis

Helical stent (SUPERA™) and drug-coated balloon (Passeo–18 Lux™) for recurrent cephalic arch stenosis: Rationale and design of arch V SUPERA–LUX Study

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