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

ACHILLES HEEL OF UPPER ARM
B-C AV FISTULAS
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

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 Cephalic-
Subclavian Junction
(Most Common type)

Focal Lesion in Mid Cephalic
Arch

Diffuse Long Segment Stenosis of the Cephalic Arch

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:
(W.L.GORE)
- Extremely Flexible with
Excellent Radial Support
- Very Easy to Handle and
Deploy

Viabahn is a Flexible Stent Graft

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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