Ming-Feng Li
Current Position
Attending physician and assistant professor of radiology
Kaohsiung Veterans General Hospital
Access Session

Topic: Undersized stent graft for treatment of cephalic arch stenosis in arteriovenous hemodialysis access


Cephalic arch stenosis (CAS) is a common cause of AV dialysis access failure and is notoriously difficult to treat with conventional venoplasty. Although stent graft (SG) placement has improved patency rate, they are prone to stent failure caused by edge stenosis, defined by stenosis at the interface between SG and adjacent vessel wall, within 5mm of its margin.
To the best of our knowledge, there have not been any previous studies discussing the optimal SG sizing for improving primary patency time in patients with cephalic arch stenosis. As a result, interventionists continue to follow the guidelines found in the each stent graft manual, which recommend of oversizing SG by 5-20% of the original vessels11. In doing so, we noticed low SG patency rate with frequent reinterventions necessary to maintain patency. On the other hand, we noticed higher patency rate in patients with SGs smaller than the diameter of the cephalic vein, requiring less reinterventions. As a result, we retrospectively reviewed CAS patients undergoing SG placement, and evaluated the effect of undersized or apposed SGs, relative to the adjacent cephalic vessel, on the clinical outcomes of patients with CAS.
According to the results of our study, undersized SG is associated with higher primary stent and access patency rate, and decreased number of post-SG interventions, and is suggested in the treatment of cephalic arch stenosis. In this presentation, I would talk about the tips and tricks of SG placement in treating CAS as well as our study results.