Use of the Viabahn stent graft for the treatment of recurrent cephalic arch stenosis in hemodialysis accesses Gregg A. Miller, MD, Dean C. Preddie, MD,

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Presentation transcript:

Use of the Viabahn stent graft for the treatment of recurrent cephalic arch stenosis in hemodialysis accesses Gregg A. Miller, MD, Dean C. Preddie, MD, Yevgeny Savransky, MD, Lawrence M. Spergel, MD Journal of Vascular Surgery Volume 67, Issue 2, Pages 522-528 (February 2018) DOI: 10.1016/j.jvs.2017.08.018 Copyright © 2017 The Authors Terms and Conditions

Fig 1 Angiographic images of the cephalic arch with the arm in the supine position. A, Representative image of a dilated brachiocephalic fistula as it tapers down and becomes tortuous as it crosses the deltopectoral groove, stenotic at the cephalic arch. B, Representative image of placement of the Viabahn device (highlighted in red) in the cephalic vein, at the cephalic arch, and crossing the ostium into the subclavian vein. Journal of Vascular Surgery 2018 67, 522-528DOI: (10.1016/j.jvs.2017.08.018) Copyright © 2017 The Authors Terms and Conditions

Fig 2 Kaplan-Meier survival estimate of primary patency rates with 95% confidence intervals. The stent graft (SG) cohort demonstrated statistically greater survival probability during the 1-year study period based on log-rank statistical analysis compared with the other cohorts (P < .001). BMS, Bare-metal stent; CAS, cephalic arch stenosis; PTA, percutaneous transluminal angioplasty. Journal of Vascular Surgery 2018 67, 522-528DOI: (10.1016/j.jvs.2017.08.018) Copyright © 2017 The Authors Terms and Conditions

Fig 3 Intervention rates reported for the three treatment modalities for the first year of follow-up. The stent graft (SG) cohort showed a statistically significant lower intervention rate than the other two cohorts. BMS, Bare-metal stent; PTA, percutaneous transluminal angioplasty. Journal of Vascular Surgery 2018 67, 522-528DOI: (10.1016/j.jvs.2017.08.018) Copyright © 2017 The Authors Terms and Conditions

Fig 4 Kaplan-Meier survival estimate of secondary access patency for each treatment group with 95% confidence intervals. The percutaneous transluminal angioplasty (PTA) cohort demonstrated statistically lower survival probability at 2.5 years based on log-rank statistical analysis compared with the stent graft (SG) cohort (P = .034). BMS, Bare-metal stent; CAS, cephalic arch stenosis. Journal of Vascular Surgery 2018 67, 522-528DOI: (10.1016/j.jvs.2017.08.018) Copyright © 2017 The Authors Terms and Conditions

Fig 5 Representative image of juxtasubclavian stenosis (JSS) associated with the placement of a bare-metal stent (BMS) in the cephalic arch and a “tented” axillary vein. Journal of Vascular Surgery 2018 67, 522-528DOI: (10.1016/j.jvs.2017.08.018) Copyright © 2017 The Authors Terms and Conditions