Cephalic arch stenosis: an analysis of outcome by type of first intervention
Abstract Background Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS....
| Päätekijät: | , , , |
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| Aineistotyyppi: | Artikkeli |
| Kieli: | English |
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SpringerOpen
2024-01-01
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| Sarja: | CVIR Endovascular |
| Aiheet: | |
| Linkit: | https://doi.org/10.1186/s42155-023-00424-4 |
| _version_ | 1827377079442735104 |
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| author | Umberto Pisano Karen Stevenson Ram Kasthuri David Kingsmore |
| author_facet | Umberto Pisano Karen Stevenson Ram Kasthuri David Kingsmore |
| author_sort | Umberto Pisano |
| collection | DOAJ |
| description | Abstract Background Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS. Methods Retrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via χ2 or Fisher’s; nonparametric tests used for skewed data. Kaplan–Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP. Results One hundred one brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%, p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01). Conclusions SG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity. |
| first_indexed | 2024-03-08T12:33:42Z |
| format | Article |
| id | doaj.art-b0281a74574d4169a9acc5f26632d5e0 |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-03-08T12:33:42Z |
| publishDate | 2024-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-b0281a74574d4169a9acc5f26632d5e02024-01-21T12:36:53ZengSpringerOpenCVIR Endovascular2520-89342024-01-017111010.1186/s42155-023-00424-4Cephalic arch stenosis: an analysis of outcome by type of first interventionUmberto Pisano0Karen Stevenson1Ram Kasthuri2David Kingsmore3Radiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and ClydeRenal Transplant Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and ClydeRadiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and ClydeRenal Transplant Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and ClydeAbstract Background Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS. Methods Retrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via χ2 or Fisher’s; nonparametric tests used for skewed data. Kaplan–Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP. Results One hundred one brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%, p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01). Conclusions SG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity.https://doi.org/10.1186/s42155-023-00424-4Cephalic archAngioplastyStent graft |
| spellingShingle | Umberto Pisano Karen Stevenson Ram Kasthuri David Kingsmore Cephalic arch stenosis: an analysis of outcome by type of first intervention CVIR Endovascular Cephalic arch Angioplasty Stent graft |
| title | Cephalic arch stenosis: an analysis of outcome by type of first intervention |
| title_full | Cephalic arch stenosis: an analysis of outcome by type of first intervention |
| title_fullStr | Cephalic arch stenosis: an analysis of outcome by type of first intervention |
| title_full_unstemmed | Cephalic arch stenosis: an analysis of outcome by type of first intervention |
| title_short | Cephalic arch stenosis: an analysis of outcome by type of first intervention |
| title_sort | cephalic arch stenosis an analysis of outcome by type of first intervention |
| topic | Cephalic arch Angioplasty Stent graft |
| url | https://doi.org/10.1186/s42155-023-00424-4 |
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