Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas

• Published in: The journal of vascular access Vol. 18; no. 4; pp. 319 - 324
• Main Authors: Balamuthusamy, Saravanan, Reddi, Alagarsamy Lakku, Madhrira, Machaiah H., Sankarapandian, Balamurugan, Nguyen, Peter, Vallurupalli, Avinash, Gabbard, William, Jalandhara, Nishant, Yurvati, Albert
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-07-2017
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty; Angioplasty, Balloon - adverse effects; Arteriovenous Shunt, Surgical - adverse effects; Brachial Artery - diagnostic imaging; Brachial Artery - physiopathology; Brachial Artery - surgery; Decision Support Techniques; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - therapy; Humans; Male; Middle Aged; Predictive Value of Tests; Recurrence; Renal Dialysis; Retreatment; Retrospective Studies; Risk Assessment; Risk Factors; Texas; Time Factors; Treatment Outcome; Upper Extremity - blood supply; Veins - diagnostic imaging; Veins - physiopathology; Veins - surgery; Fistula; End-stage renal diseases (ESRD); Recurrent stenosis and endovascular re-intervention; Cephalic arch stenosis (CAS)
• ISSN: 1129-7298; 1724-6032
• DOI: 10.5301/jva.5000734

Introduction
Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis.
Methods
Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software.
Results
The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50% of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis.
Conclusions
Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.