Abstract No. 82: Restenosis in the Cephalic Vein Arch Following PTA or Covered Stent Placement: A Retrospective Image Analysis from the AVeNEW Trial
A new retrospective image analysis of patients with cephalic vein arch stenosis (CAS) in their arteriovenous fistula (AVF) indicates that the use of covered stents may provide superior target lesion primary patency (TLPP) than angioplasty (PTA) alone.
Guilherme Strieder de Oliveira, MD
Researchers utilized data from the AVeNEW IDE Trial, a large, randomized study that compared PTA to covered stents for treating stenoses in dysfunctional AVF. According to Guilherme Strieder de Oliveira, MD, lead author of Restenosis in the Cephalic Vein Arch Following PTA or Covered Stent Placement—A Retrospective Image Analysis from the AVeNEW Trial, one of the SIR 2025 Featured Abstracts, CAS was quite common in the AVeNEW trial, with 148 out of 280 patients (53%) having stenosis at that location.
“More than half of the randomized patients underwent treatment of stenosis in the cephalic vein arch, a challenging anatomic zone with unique considerations for endovascular intervention,” Dr. Oliveira said. “Given the large number of patients with CAS and the known challenges of this anatomy, we sought to definitively answer whether covered stents improved patency compared to angioplasty alone for this subset of patients.”
Researchers found that at 180 days, the TLPP was 75.4% in the covered stent group versus 39.5% in the PTA group. This disparity widened over time, with 1-year TLPP rates of 49.8% and 13.2%, and 2-year TLPP rates of 28.9% and 5.6% for covered stents and PTA, respectively.
“By demonstrating superior primary patency with covered stents versus angioplasty alone, this study provides data supporting treatment of CAS with a covered stent,” Dr. Oliveira said. “Furthermore, prior reports describe restenosis of CAS using a binary reporting outcome—either restenotic or not. We felt that by using our detailed mapping of restenosis locations, we could gain insight into why PTA and covered stents fail to maintain patency.”
Dr. Oliveira, along with fellow author Bart L. Dolmatch, MD, FSIR, also meticulously analyzed the patterns of restenosis following both PTA and covered stent placement, categorizing the initial stenosis location as either proximal, arch or terminus. They found that terminus stenoses had a high recurrence rate in the terminus zone after PTA. Arch stenoses treated with PTA often recurred in the arch zone, but sometimes developed restenoses in the terminus zone. In contrast, new stenoses developed in the covered stent group predominantly occurred at the stent edges (75%).
“By identifying specific anatomic zones within the cephalic arch that are prone to recurrence, we hope to provide a better understanding of the location of restenosis that may help refine future treatment strategies and device designs, and perhaps even lead to an understanding for why restenosis occurred,” Dr. Oliveira said.
The team plans to further validate and expand upon these findings by analyzing an additional 75 patients from the post-approval phase of the AVeNEW trial who were treated with covered stents.
“Once that is done, we will have data on over 150 patients with CAS treated with a covered stent and be more confident in the patterns of loss of target lesion primary patency using a covered stent in the cephalic vein arch,” Dr. Oliveira said.
Dr. Oliveira will present his findings at SIR 2025 on Sunday, March 30, at 3.p.m. during the Venous 1 session.
