Division of Nephrology and Hypertension, Saratoga Hospital, Saratoga Springs, NY, USA.
Semin Nephrol. 2012 Nov;32(6):538-44. doi: 10.1016/j.semnephrol.2012.10.004.
Cephalic arch is a frequent site for the development of stenosis in patients with brachiocephalic fistulae. This is in part owing to the anatomic constraints of the cephalic arch region and the exertion of hemodynamic forces at this site caused by the creation of a brachiocephalic fistula. Multiple interventions have been used to correct stenosis and subsequent fistula dysfunction. These include percutaneous balloon angioplasty using conventional and cutting balloons, endovascular stent insertion, and surgical interventions. It is important to emphasize that the stenosis in this region frequently recurs, is more resistant to angioplasty, and shows a higher rate of rupture during the percutaneous balloon angioplasty procedure compared with peripheral lesions at other sites. Because hemodynamic forces have been postulated to be one of the culprits for the development of stenosis, a new technique of flow reduction has been introduced to combat this problem. This article discusses the etiology, pathophysiology, and current management of cephalic arch stenosis.
头臂动脉吻合术后，锁骨下动脉狭窄多发生在头臂动脉弓部位。这在一定程度上是由于头臂动脉弓区域的解剖限制，以及头臂动脉吻合术导致此处血流动力学的变化。目前已经有多种介入治疗方法用于纠正狭窄和随后的瘘管功能障碍，包括使用传统和切割球囊的经皮腔内血管成形术、血管内支架置入术和外科手术。重要的是要强调，该区域的狭窄经常复发，对血管成形术的反应更差，并且与其他部位的外周病变相比，在经皮球囊血管成形术中更容易发生破裂。由于血流动力学因素被认为是狭窄发展的原因之一，因此引入了一种新的血流减少技术来解决这个问题。本文讨论了头臂动脉弓狭窄的病因、病理生理学和目前的治疗方法。
