Kim Hyangkyoung, Kim Young Shin, Labropoulos Nicos
Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea.
Department of Preventive Medicine, Korea University School of Medicine, Seoul, Korea.
J Vasc Access. 2025 Jul;26(4):1229-1240. doi: 10.1177/11297298241264583. Epub 2024 Aug 3.
Cephalic arch stenosis (CAS) is often recurrent, resistant to treatment and the intervention outcome is not well validated so far. We purposed to assess the clinical outcomes of CAS treatment in patients with hemodialysis access.
Electronic bibliographic sources were searched up to December 4 2023 to identify studies reported outcome after treating CAS. Direct and indirect evidence was combined to compare odds ratios (OR) and surfaces under the cumulative ranking curves across the different treatment modalities through meta-analysis and network meta-analyses (NMA). This systematic review was conducted in accordance with the PRISMA-P. The review is registered in PROSPERO (CRD42022296513).
Four randomized controlled trials (RCTs) and 15 non-RCTs were included in the analysis. The study population differed in fistula type, restenosis or thrombosis, and significant heterogeneity was observed among the publications. The risk of bias was low to serious. Meta-analysis found no significant difference between DCB and PTA in primary patency at 6 and 12 months (OR 1.16 and 0.60, respectively; low certainty of evidence). Favorable result with STG compared to stent or PTA at 3, 6, and 12 month was observed (OR 4.28, 5.13, and 13.12, and 4.28, 5.13, 13.12, respectively; low certainty of evidence). Regarding primary patency, the treatment rankings, from highest to lowest, were STG (92.7%), transposition (76.0%), stent (67.5%), DCB (46.3%), and PTA (64.5%) at 12 months.
Despite data limitations, the low-quality evidence suggests that STG may merit consideration as a primary treatment option when all alternatives are applicable, given their potential for better primary patency and higher treatment ranking.
头臂动脉狭窄（CAS）常反复发生，治疗效果不佳，且目前干预结果尚未得到充分验证。我们旨在评估血液透析通路患者CAS治疗的临床结局。
检索截至2023年12月4日的电子文献来源，以确定报道CAS治疗后结局的研究。通过荟萃分析和网状荟萃分析（NMA），合并直接和间接证据，比较不同治疗方式的比值比（OR）和累积排序曲线下面积。本系统评价按照PRISMA-P进行。该评价已在PROSPERO注册（CRD42022296513）。
分析纳入了4项随机对照试验（RCT）和15项非RCT。研究人群在动静脉内瘘类型、再狭窄或血栓形成方面存在差异，各出版物间观察到显著异质性。偏倚风险为低到严重。荟萃分析发现，在6个月和12个月时，药物涂层球囊（DCB）和经皮腔内血管成形术（PTA）在初始通畅率方面无显著差异（OR分别为1.16和0.60；证据确定性低）。在3个月、6个月和12个月时，与支架或PTA相比，覆膜支架移植物（STG）显示出良好效果（OR分别为4.28、5.13和13.12，以及4.28、5.13、13.12；证据确定性低）。关于初始通畅率，12个月时治疗排名从高到低依次为STG（92.7%）、转位术（76.0%）、支架（67.5%）、DCB（46.3%）和PTA（64.5%）。
尽管存在数据局限性，但低质量证据表明，鉴于STG在初始通畅率方面具有更好的潜力和更高的治疗排名，在所有替代方案都适用的情况下，可考虑将其作为主要治疗选择。
