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Brachial Arterial Access: Endovascular Treatment of Failing Brescia-Cimino Hemodialysis Fistulas—Initial Success and Long-Term Results¹

¹ From the Departments of Clinical Radiology (H.I.M., E.T.K., P.M.), Medicine (R.I., P.K., E.L.), and Radiotherapy (T.L.), Kuopio University Hospital, Puijonlaaksontie 2, PO Box 1777, FIN-70211 Kuopio, Finland. Received February 16, 2000; revision requested March 27; final revision received June 30; accepted July 25. Supported by a grant from Kuopio University Hospital. Address correspondence to H.I.M. (e-mail: Hannu.Manninen@kuh.fi)

PURPOSE: To evaluate safety and efficacy of endovascular interventions in failing antebrachial Brescia-Cimino hemodialysis fistulas in consecutive patients.

MATERIALS AND METHODS: Altogether, 103 interventions were performed in 53 Brescia-Cimino shunts in 51 patients by means of antegrade brachial arterial access. Twelve interventions were initiated with pharmacomechanical thrombolysis and/or thromboaspiration. All interventions included balloon angioplasty that was completed with stent placement in eight cases and with endovascular brachytherapy with an iridium 192 source in five cases.

RESULTS: The technical success rate of the primary interventions was 92% (49 of 53) and that for all interventions was 95% (98 of 103). The rate of major complications was 4% (four of 103). Clinical success was achieved in 92% (95 of 103) of the interventions. By including the initial failures, 58% ± 7 (standard error of the estimate), 44% ± 8, 40% ± 8, and 32% ± 10 primary and 90% ± 5, 85% ± 5, 79% ± 7, and 79% ± 7 secondary clinical patency rates were registered at 6 months and 1, 2, and 3 years, respectively, by means of Kaplan-Meier analysis. The location of the main treated lesion at the arteriovenous anastomosis (P = .03) was a predictor of poorer long-term patency.

CONCLUSION: Endovascular interventions with antegrade brachial arterial access are highly effective in restoring function in failing Brescia-Cimino fistulas.

Index terms: Arteries, transluminal angioplasty, 91.454 • Dialysis, shunts, 91.1282, 91.442, 91.454, 91.457 • Grafts, interventional procedures, 91.1282, 91.454, 91.457 • Grafts, stenosis or thrombosis, 91.1282, 91.442, 91.454, 91.457 • Thrombolysis, 91.1265

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