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When a CAS occurs, the management is not easy. Angioplasty of stenotic lesions involving the cephalic arch has limited effectiveness, which led investigators to seek surgical alternatives to treat these lesions and to preserve current fistula [1]. The option for cephalic vein transposition (CVT), described by Chen et al., involves surgical revision to redirect the blood flow to the adjacent patient veins. The surgical procedure entailed transecting the healthy portion of the cephalic vein distal Quisinostat to the stenotic segment in the arch, transposing and anastomosing it to the upper basilic [2] (Figure ?(Figure11). Fig.?1. Illustration of the cephalic vein transposition technique. We present the experience of our centre with upper arm CVT procedures in three haemodialysis patients who underwent haemodialysis treatment in the haemodialysis unit of Centro Hospitalar de Set��bal E.P.E. Two of the 3 cases did not have the possibility of endovascular treatment. In these cases CVT to basilic vein made possible the preservation of vascular access. Both accesses are patents to date, 6 and 9 months, respectively. In the other case, the CVT allowed the reduction of percutaneous transluminal angioplasties (PTAs)/access-year in a patient with frequent recurrent CAS (requiring angioplasty in ankyrin and is also patent to date (52 months). Case reports Clinical and demographics aspects of the cases are summarized in Table?1. Table?1. Patient demographics and baseline characteristics selleck screening library Discussion When failure of vascular access is imminent, it is important to know all management options in order to be able to choose the best solution for the patient, allowing preservation of the access. Angioplasty of stenotic lesions involving the cephalic arch has limited effectiveness as immediate elastic recoil, venous rupture and rapid re-growth of venous intimal hyperplasia results in a 42% primary patency at 6 months [2, 3]. Limited information is available on the outcomes of stent and stent graft in the management of CAS. Placement of stents improves immediate patency, but no study has yet established the superiority of stents over percutaneous balloon angioplasty for CAS. The curvature of this venous segment and the proximity to the confluence with the subclavian vein can complicate this procedure. The migration of the stent into the clavian vein can cause problems in the creation of an arteriovenous fistula using the basilic system [1, 4]. In many patients, rapid re-stenosis occurs and repeated interventions become necessary to maintain access patency and haemodialysis adequacy. Additionally, some lesions are not amenable to endovascular intervention because of cephalic arch total occlusion. Some studies demonstrate that CVT is an available option for fistula preservation, as showed by the clinical cases presented in this report.
