Viabahn Covered Stents for Cephalic Arch Stenosis Can

Report
Viabahn Covered Stents for
Cephalic Arch Stenosis Can
Improve Patency and Longevity
of Upper Arm AV Fistulas
Toufic Safa, MD, FACS
Vascular & Endovascular Surgery
St. Francis Hospital, Roslyn NY
CEPHALIC ARCH STENOSIS:
ACHILLES HEEL OF UPPER ARM
B-C AV FISTULAS
1- Why it happens? Not fully understood
2- Symptoms Include:
a- Aneurysmal Degenaration with expansion
of Fistula vein size
b- Increased Pulsatility of Vein with excessive
bleeding after decannulation
c- Poor Clearance on Hemodialysis
3- Diagnosis can be suspected on physical exam and
confirmed by duplex scanning or an angiogram
ANEURYSMAL
AV FISTULAS
CEPHALIC ARCH STENOSIS:
TYPES OF LESIONS
1- Focal Lesion at the cephalic/Subclavian
vein junction (Most Common Type)
2- Focal Lesion in the Mid Cephalic Arch
3- Diffuse Long Segment Stenosis of the
cephalic arch
Focal Lesion at the CephalicSubclavian Junction
(Most Common type)
Focal Lesion in Mid Cephalic Arch
Diffuse Long Segment Stenosis of
the Cephalic Arch
CEPHALIC ARCH STENOSIS:
MANAGEMENT OPTIONS
1- Percutaneous Balloon Angioplasty
2- Angioplasty and Stenting (Bare Metal vs. Covered
Stent)
3- Open Surgical Patch Angioplasty
4- Cephalic Vein “Turndown” or transposition and
anastomosis to a deep vein
5- Surgical bypass with PTFE: Cephalic vein to Internal
Jugular vein
6- Ligate/Abandon upper arm AV fistula and create a
new one elsewhere
ANGIOPLASTY:
6 month patency 22%
Fear of Rupture of Vein
Rapid Restenosis
ANGIOPLASTY + BM STENT:
6 month patency 43%
Rapid in stent stenosis
Stent Fractures
Subclavian vein occlusion
BM STENT FRACTURE
with OCCLUSION
Open Patch Angioplasty
of the cephalic arch
SURGICAL BYPASS OF THE
CEPHALIC ARCH STENOSIS
CHOICE OF COVERED STENT:
VIABAHN®
(W.L.GORE)
- Extremely Flexible with
Excellent Radial Support
- Very Easy to Handle and
Deploy
Viabahn is a Flexible Stent Graft
CASE EXAMPLE #1
CASE EXAMPLE #2
CASE EXAMPLE #3
VIABAHN IN THE CEPHALIC ARCH:
OUR EXPERIENCE
Retrospective analysis: 21 patients (13 males and 8
females) treated with angioplasty and Viabahn Stent
placement in the cephalic arch over a 2 year period.
Age Range is 44-87 years
Stent size was 7-10mm in diameter and 10cm long
(8mm was the most common diameter)
17 fistulas were in the left upper extremity and 5 in the
right
3 patients died during follow-up due to non access related
causes
VIABAHN IN THE CEPHALIC ARCH:
OUR EXPERIENCE
RESULTS:
7 patients returned for repeat interventions:
5 interventions were due to recurrent
lesions at the cephalic arch and the others
were due to lesions elsewhere in the fistula
1° Patency was 66%
2° Patency was 100%
Freedom from TLR was over 75%
RECURRENT CEPHALIC ARCH
STENOSIS
PRE:
POST:
VIABAHN IN THE CEPHALIC ARCH:
OUR EXPERIENCE
RESULTS:
Recurrent stenoses post VIABAHN
stent placement in the cephalic
arch tend to be EDGE stenoses
similar to stenoses that develop in
the SFA after VIABAHN stent
therapy
VIABAHN IN THE CEPHALIC ARCH:
OUR EXPERIENCE
CONCLUSION:
- Excellent access patency rates and
freedom from TLR can be achieved
when VIABAHN stent grafts are used
in the cephalic arch
- Larger patient population and longer
follow-up period are necessary to
validate our statements
THANK YOU

similar documents