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Toufic Safa , MD, FACS Vascular & Endovascular Surgery St. Francis Hospital, Roslyn NY

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. 1 - Why it happens? Not fully understood 2- Symptoms Include:

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Toufic Safa , MD, FACS Vascular & Endovascular Surgery St. Francis Hospital, Roslyn NY

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  1. Viabahn Covered Stents for Cephalic Arch Stenosis Can Improve Patency and Longevity of Upper Arm AV Fistulas TouficSafa, MD, FACS Vascular & Endovascular Surgery St. Francis Hospital, Roslyn NY

  2. 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 CEPHALIC ARCH STENOSIS: Achilles Heel of Upper armB-C AV Fistulas

  3. ANEURYSMAL AV FISTULAS

  4. 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 CEPHALIC ARCH STENOSIS: Types of Lesions

  5. Focal Lesion at the Cephalic-Subclavian Junction (Most Common type)

  6. Focal Lesion in Mid Cephalic Arch

  7. Diffuse Long Segment Stenosis of the Cephalic Arch

  8. 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 CEPHALIC ARCH STENOSIS: Management Options

  9. ANGIOPLASTY: 6 month patency 22%Fear of Rupture of VeinRapid RestenosisANGIOPLASTY + BM STENT: 6 month patency 43%Rapid in stent stenosisStent FracturesSubclavian vein occlusion

  10. BM STENT FRACTURE with OCCLUSION

  11. Open Patch Angioplasty of the cephalic arch

  12. SURGICAL BYPASS OF THE CEPHALIC ARCH STENOSIS

  13. - Extremely Flexible with Excellent Radial Support - Very Easy to Handle and Deploy CHOICE of COVERED STENT: VIABAHN®(W.L.GORE)

  14. Viabahnis a Flexible Stent Graft

  15. CASE EXAMPLE #1

  16. CASE EXAMPLE #2

  17. CASE EXAMPLE #3

  18. 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

  19. RESULTS: 7patients 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% VIABAHN IN THE CEPHALIC ARCH:Our Experience

  20. RECURRENT CEPHALIC ARCH STENOSIS PRE: POST:

  21. RESULTS: Recurrentstenosespost VIABAHN stent placement in the cephalic arch tend to be EDGEstenoses similar to stenoses that develop in the SFA after VIABAHN stent therapy VIABAHN IN THE CEPHALIC ARCH:Our Experience

  22. CONCLUSION: Excellent access patency rates and freedom from TLRcan 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 VIABAHN IN THE CEPHALIC ARCH:Our Experience

  23. THANK YOU

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