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논문분류	춘계학술대회 초록집
제목	Recurrent cephalic arch stenosis: How to treat it?
저자	Yong-Soo Kim
출판정보	2016; 2016(1):
키워드
초록	Cephalic arch stenosis (CAS) is the most common stenosis in brachiocephalic fistula. Conventional percutaneous transluminal angioplasty (PTA) has been the first choice to treat CAS in dysfunctional arteriovenous fistula (AVF). Most current treatment is limited to repeat PTA. However, recurrent stenosis and low primary patency rate after PTA often occur. Other percutaneous techniques have been tried to examine the outcome of CAS and to compare the outcome with conventional PTA. They include cutting balloon angioplasty, bare metal stent or stent graft, and endovascular banding (MILLER) procedure to reduce inflow. Surgical treatment includes venovenostomy with transposition of the cephalic vein and anastomosis to the axillary vein. There are limited studies to examine the outcome with each technique, and most of them are retrospective studies. Superiority of cutting balloon angioplasty in CAS has not been determined because of limited data. Bare metal stents demonstrate no improvement in primary patency compared with PTA. Stent grafts are superior to bare metal stents in CAS and offer a potential alternative to PTA. Surgical revision (venovenostomy) seems to provide longer secondary patency and lower number of interventions. However, the surgical procedures are heterogeneous in the studies, and we need to think it inhibits future creation of basilica vein fistula. Endovascular banding is minimally invasive and safe procedure to reduce inflow. A retrospective study by Miller et al. and our study showed decreased number of interventions per year in patients with recurrent CAS after banding procedure. In addition, our study demonstrates that high maximal diameter of distal cephalic vein to diameter of cephalic arch ratio is an independent risk factor for CAS. PTA together with inflow reduction seems to prolong primary patency after PTA in high risk patients with recurrent CAS. To confirm this finding, prospective long-term study with large sample size is needed.
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