Cristina Cacndido
Centro Hospital de Setubal - Sao Bernardo Hospital, Portugal
Title: Transposition of the cephalic vein in cephalic arch stenosis, an alternative approach
Biography
Biography: Cristina Cacndido
Abstract
Brachiocephalic arteriovenous fistula is the most commonly used and one of the favored hemodialysis access options. Often, these fistulas are associated with drainage disfunction in the Cephalic arch. This terminal portion of the cephalic vein is a frequent site for the development of stenosis. Various strategies have been applied to manage the stenosis, although, in some cases, it is not possible to intervene and access failure occurs. Cephalic vein transposition (CVT) to basilic vein is an alternative approach rarely described in literature for treatment of cephalic arch occlusive lesions. We report two haemodialysis patients, a 41 year-old woman and a 91 year-old man, with brachiocephalic fistula created 18 and 36 months ago respectively, that developed cephalic arch stenosis. In both cases the possibility of endovascular treatment was excluded, and surgical treatment was selected through CVT to basilica vein. In the first case, the access remains patent up to present day (6 months after CVT). In the second case, 9 months after surgical revision, a stenosis occurred close to the re-anastomosis and was treated by percutaneous balloon angioplasty, remaining patent also up to present day (12 months after CVT). The purpose of our study is to demonstrate an alternative approach for preserving brachiocephalic fistula with cephalic arch occlusive lesions. These results might encourage surgeons and nephrologists in Portugal to consider this strategy as a viable option.