Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas

Saravanan Balamuthusamy, Alagarsamy Lakku Reddi, Machaiah H. Madhrira, Balamurugan Sankarapandian, Peter Nguyen, Avinash Vallurupalli, William Gabbard, Nishant Jalandhara, Albert Yurvati

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis. Methods: Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software. Results: The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50% of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis. Conclusions: Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.

Original languageEnglish
Pages (from-to)319-324
Number of pages6
JournalJournal of Vascular Access
Volume18
Issue number4
DOIs
StatePublished - 1 Jan 2017

Fingerprint

Fistula
Pathologic Constriction
Head
Angioplasty
Venous Pressure
Blood Vessels
Renal Dialysis
Theoretical Models
Referral and Consultation
Software
Hemorrhage
Costs and Cost Analysis
Survival

Keywords

  • Cephalic arch stenosis (CAS)
  • End-stage renal diseases (ESRD)
  • Fistula
  • Recurrent stenosis and endovascular re-intervention

Cite this

Balamuthusamy, Saravanan ; Reddi, Alagarsamy Lakku ; Madhrira, Machaiah H. ; Sankarapandian, Balamurugan ; Nguyen, Peter ; Vallurupalli, Avinash ; Gabbard, William ; Jalandhara, Nishant ; Yurvati, Albert. / Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas. In: Journal of Vascular Access. 2017 ; Vol. 18, No. 4. pp. 319-324.
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abstract = "Introduction: Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis. Methods: Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software. Results: The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50{\%} of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis. Conclusions: Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.",
keywords = "Cephalic arch stenosis (CAS), End-stage renal diseases (ESRD), Fistula, Recurrent stenosis and endovascular re-intervention",
author = "Saravanan Balamuthusamy and Reddi, {Alagarsamy Lakku} and Madhrira, {Machaiah H.} and Balamurugan Sankarapandian and Peter Nguyen and Avinash Vallurupalli and William Gabbard and Nishant Jalandhara and Albert Yurvati",
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Balamuthusamy, S, Reddi, AL, Madhrira, MH, Sankarapandian, B, Nguyen, P, Vallurupalli, A, Gabbard, W, Jalandhara, N & Yurvati, A 2017, 'Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas', Journal of Vascular Access, vol. 18, no. 4, pp. 319-324. https://doi.org/10.5301/jva.5000734

Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas. / Balamuthusamy, Saravanan; Reddi, Alagarsamy Lakku; Madhrira, Machaiah H.; Sankarapandian, Balamurugan; Nguyen, Peter; Vallurupalli, Avinash; Gabbard, William; Jalandhara, Nishant; Yurvati, Albert.

In: Journal of Vascular Access, Vol. 18, No. 4, 01.01.2017, p. 319-324.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas

AU - Balamuthusamy, Saravanan

AU - Reddi, Alagarsamy Lakku

AU - Madhrira, Machaiah H.

AU - Sankarapandian, Balamurugan

AU - Nguyen, Peter

AU - Vallurupalli, Avinash

AU - Gabbard, William

AU - Jalandhara, Nishant

AU - Yurvati, Albert

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Introduction: Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis. Methods: Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software. Results: The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50% of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis. Conclusions: Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.

AB - Introduction: Cephalic arch stenosis is one of the most common reasons for repeated endovascular intervention and eventual abandonment of access in hemodialysis patients. There is no prediction model to identify risk factors for recurrent cephalic arch stenosis. We have developed a mathematical model to predict the need for reintervention in brachiocephalic (BC) fistulas with recurrent cephalic arch stenosis. Methods: Single-center retrospective analysis of 143 patients with a BC fistula referred to the vascular clinic for access dysfunction who underwent cephalic arch angioplasty were included for the analysis. Twelve-month post-index angioplasty data were analyzed using parametric, non-parametric and multiple regression models using SPSS software. Results: The mean need for re-intervention in 1 year since first index visit was 2.46 ± 1.404. Statistically significant correlation (p≤0.001) for re-intervention was observed with the severity of stenosis at index visit, access flow, vessel wall diameter proximal to the stenosis, average venous pressure >50% of the delivered blood flow rate and prolonged bleeding for >30 minutes as a reason for referral. Three equations have been derived for calculating the need for re-intervention based on the diameter of the vessel wall proximal to the stenosis. Conclusions: Risk stratification of BC fistulas utilizing the above parameters could enable clinicians to identify accesses that are at risk for multiple re-interventions. Early identification of accesses that are at high risk for re-interventions at the cephalic arch might prolong access survival and reduce the cost for intervention by utilizing alternate strategies.

KW - Cephalic arch stenosis (CAS)

KW - End-stage renal diseases (ESRD)

KW - Fistula

KW - Recurrent stenosis and endovascular re-intervention

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DO - 10.5301/jva.5000734

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SP - 319

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JO - Journal of Vascular Access

JF - Journal of Vascular Access

SN - 1129-7298

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