Cephalic Arch Stenosis and the Surgical Treatment

Abstract

Because of the risk of venous rupture and the high rate of restenosis with angioplasty, we performed a surgical treatment for two dialysis patients with cephalic arch stenosis (82-year-old woman, and 76-year-old man). They had a loop-type prosthetic arteriovenous fistula at the right forearm. Previous prosthetic vascular graft was anastomosed with a new prosthetic vascular graft and the opposite site of the new graft was anastomosed with distal site of the basilic vein to transpose the blood flow from the cephalic vein to the basilic vein. After the operation, the venous dialysis pressure decreased, flow volume at the brachial artery increased, and resistance index decreased. The benefit of this surgical procedure is to preserve proximal site of the basilic vein for future creation of new vascular access.