Objective: To evaluate the clinical efficacy of transposition of the cephalic vein to the basilic or axillary vein plus arteriovenous fistula constriction in treatment of cephalic arch stenosis (CAS) in patients with high-flow brachiocephalic fistula (BCF).
Methods: Between January 2014 and June 2017, 22 patients with high-flow BCF admitted due to CAS were selected, and then underwent transposition of the cephalic vein to the basilic or axillary vein plus arteriovenous fistula constriction. The changes in fistula hemodynamics 24 h after operation were measured by Doppler ultrasound, and the postoperative primary and secondary patency rates were also observed.
Results: Of the 22 patients before operation, the average time of hemodialysis was (73.5±44.4) months, the average inner diameter of the cephalic arch was (2.1±0.5) mm, and percutaneous transluminal angioplasty (PTA) was performed (1.9±0.4) times per patient. On 24 h after operation, the brachial resistance index and inner diameter of the brachial artery showed no significant changes (both P>0.05), but the average blood flow of the brachial artery and inner diameter of the anastomosis/venous outflow track were significantly reduced compared with preoperative values (both P<0.05). The patients were followed up for 21.5 months, the primary patency rates at 6, 12, 24 and 36 months after operation were 100%, 100%, 93.3% and 58.3% respectively, and the primary patency rate was significantly higher than that when they underwent PTA (χ2=49.23, P=0.000); all of the secondary patency rates at 6, 12, 24 and 36 months after operation were 100%. Subcutaneous hematoma occurred in only two patients after operation, which required no treatment; no thrombotic event occurred in any of the patients after operation or during the follow-up period.
Conclusion: Transposition of the cephalic vein to the basilic or axillary vein plus arteriovenous fistula constriction for CAS in patients with high-flow BCF is safe and controllable, and can provide high long-term primary patency rates.