Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas--initial success and long-term results.

Abstract

To evaluate safety and efficacy of endovascular interventions in failing antebrachial Brescia-Cimino hemodialysis fistulas in consecutive patients. 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. 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. Endovascular interventions with antegrade brachial arterial access are highly effective in restoring function in failing Brescia-Cimino fistulas.