Cephalic vein reimplantation for treating cephalic arch stenosis: A novel surgical approach

Abstract

Cephalic arch stenosis (CAS) is a well-recognized complication associated with brachiocephalic arteriovenous fistulas (BCAVFs), often necessitating intervention when symptomatic due to elevated venous pressures. We report the case of a 58-year-old lady with end-stage renal disease undergoing long-term hemodialysis via a left-sided BCAVF. She presented with progressively increased bleeding from puncture sites following dialysis sessions attributed to cephalic arch stenosis .A fistulography revealed a tortuous, zigzag-shaped stenosis at the terminal segment of the cephalic vein near the cephalo-axillary junction. The patient underwent a surgical resection of the stenotic segment and end-to-side reimplantation of the cephalic vein onto the axillary vein, through a single infraclavicular incision. The procedure was well tolerated. Postoperative outcomes included a marked reduction in venous pressures and resolution of symptoms, with stable fistula function over a 9-month follow-up period. This report highlights a novel surgical approach to cephalic arch stenosis, detailing its indications and potential advantages.