Technical aspects and results of percutaneous transluminal angioplasty in Brescia-Cimino dialysis fistulas

Abstract

Our experience with percutaneous transluminal angioplasty for treatment of stenoses and occlusions in surgically created arteriovenous fistulas (Brescia-Cimino) is reported. Methodological aspects are emphasized. Forty-nine PTAs were performed in 36 patients, in 3 combined with the use of a vascular metallic endoprosthesis (Wallstent). The initial success rates for stenoses and occlusions were 91% and 77%, respectively. Long stenoses and occlusions (greater than 4 cm) showed significantly worse initial results (55%) as compared to short ones (95%). Of the primarily successfully treated shunts, 90% are still functioning after a mean follow-up time of 8 months. The results indicate that PTA may replace surgical intervention as the primary method for treatment of insufficient flow for internal arteriovenous shunts, provided fresh thrombi are not the cause of the occlusion. Metallic endoprostheses and the use of atherectomy catheters were shown to be a valuable adjunct to classical PTA in selected cases.

Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency

“…Our PTA technique was based on standard methods reported previously [4]. Patients received 1% lidocaine local anesthesia prior to the procedure.…”

“…Many investigators have reported that Brescia-Cimino arteriovenous fistulas have several advantages to polytetrafluoroethylene grafts, especially for a longer lifetime [1,2,3,4,5,8,9,10]. Despite the increased reliability, however, Brescia-Cimino arteriovenous fistulas often require radiological or surgical interventions frequently to maintain their function [1,2,3,4,5,8,9,10].…”

“…Providing successful vascular access for hemodialysis remains one of the most challenging problems [1,2,3,4,5,6,7,8,9,10,11]. Many investigators have reported that Brescia-Cimino arteriovenous fistulas have several advantages to polytetrafluoroethylene grafts, especially for a longer lifetime [1,2,3,4,5,8,9,10].…”

“…While many investigators have described high initial success rates, the long-term patency rates reported remain unsatisfactory [1,2,3,4,5,6,7,8,9,10,11,15,16,17]. As a solution to this problem, endoluminal metallic stents have been developed in the salvage of failed hemodialysis access recanalization attempts in recent years [12,13,14,15,16,17]; however, three recent prospective randomized studies found no statistical significance in the long-term patency between lesions in which self-expanding metallic stents were placed and those treated only with PTA [15,16,17].…”

“…Percutaneous transluminal angioplasty (PTA) has been widely recognized as a suitable technique for maximizing the function of vascular access [1,2,3,4,5,6,7,8,9,10,11]. While many investigators have described high initial success rates, the long-term patency rates reported remain unsatisfactory [1,2,3,4,5,6,7,8,9,10,11,15,16,17].…”