C BURNETT1, G NICHOLLS1, A SWINBANK1, I HUGHES1, T TITUS1
1Gold Coast University Hospital, Southport, Australia
Aim: To examine the prevalence and predisposing factors for Cephalic arch stenosis (CAS) development in the arteriovenous fistula (AVF).
Background: CAS is a frequently observed complication in brachiocephalic AVF associated with high morbidity and healthcare expenditure. The predisposing factors and preventative strategies for CAS remain unclear.
Methods: A retrospective analysis was performed at the Gold Coast Hospital on patients with AVFs created from 2009-2018 with ≥18 months follow-up. CAS was defined as >50% narrowing on angiographic assessment. 187 patients with AVF were included in the analysis (36 brachiocephalic, 151 radiocephalic).
Results: CAS prevalence was 61% for brachiocephalic AVF and 6% for radiocephalic AVFs. Cox proportional hazards analysis demonstrated that brachiocephalic AVF were ≥12 times more likely to develop CAS than radiocephalic AVF (Hazard Ratio (HR) 12.7, 95% CI [5.6 to 28.3], p<0.001). Each mL/min increase in flow rate through the AVF, correlated with a 0.07% increase in the probability of development of CAS (HR 1.0007, 95% CI [1.0001, 1.0012], p=0.011). However, we demonstrated a decreased risk of CAS with increasing anastomotic width, with HR 0.70 for each additional millimetre of AVF anastomosis size (HR 0.70, 95% CI [0.54 to 0.91], p=0.01). Brachiocephalic AVFs with CAS were associated with a higher number of interventional procedures compared with their non-CAS counterparts (Median [Interquartile range]: 1 [1, 2] vs. 2 [1, 5], p = 0.052).
Conclusions: Brachiocephalic AVF with higher flow rates are more likely to develop CAS and at a faster rate, with a tendency to require a higher number of procedures. Anastomotic width may be a factor in the development of CAS. Further studies are needed to confirm this observation and devise strategies to present CAS.
Cameron Burnett is an aspiring nephrologist practicing as a Basic Physician Training at Gold Coast University Hospital. Graduating from the University of Tasmania with MBBS and Med Sci (Hons), he is completing a Masters of Public Health in Health economics and healthcare design.