Abstract
The transradial artery approach to angioplasty has rarely been reported as a method for treating dysfunctional Brescia-Cimino fistulas. This study evaluated the feasibility, safety, and 1-year efficacy of this method for treating dysfunctional Brescia-Cimino fistulas. We retrospectively evaluated 154 consecutive procedures in 131 patients (age, 58.3 ± 11.6 years; male, 48.1%) who underwent the transradial approach in dysfunctional Brescia-Cimino fistulas in the 1-year period after the procedure. The operator determined the use of a regular or a cutting balloon (two cases) in combination with urokinase injection (one case) or catheter thromboaspiration. Radial artery puncture was successful in all cases. Fifty-two cases (33.8%) had totally occluded fibrotic lesions. The overall anatomic success rate and clinical success rate were 61% (94/154) and 81.1% (125/154), respectively. In cases with a totally occluded fibrotic lesion, the clinical success rate was 46%. Successful intervention was associated with a significant reduction in the radial arterial systolic and diastolic pressures. There were no complications of symptomatic arterial embolization or pulmonary embolism, and one complication of venous rupture was successfully treated by compression. The primary patency rates based on intention-to-treat were 75.3% at 30 days and 39.0% at 1 year after the procedure. Excluding the cases with a totally occluded lesion, the clinical success rate was 99% (101/102) and the primary patency rates were 84.3% (86/102) and 52.0% (53/102) at 3 months and 1 year after the procedure, respectively. In conclusion, the transradial approach is a feasible, safe, and effective alternative for catheter intervention for dysfunctional Brescia-Cimino fistulas. Its success rate in cases with a totally occluded fibrotic lesion is unsatisfactory.
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References
Hemodialysis Adequacy Work Group (2006) Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 48(Suppl 1):S2–S90
Glanz S, Bashist B, Gordon DH, Butt K, Adamsons R (1982) Angiography of upper extremity access fistulas for dialysis. Radiology 143:45–52
Kanterman RY, Vesely TM, Pilgram TK et al (1995) Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty. Radiology 195:135–139
Rajan DK, Bunston S, Misra S et al (2004) Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty—are there clinical predictors of patency? Radiology 232:508–515
Turmel-Rodrigues L, Pengloan J, Rodrigues H et al (2000) Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int 57:1124–1140
Gordon DH, Glanz S, Butt KM et al (1982) Treatment of stenotic lesions in dialysis access fistulas and shunts by transluminal angioplasty. Radiology 143:53–58
Manninen HI, Kaukanen ET, Ikaheimo R et al (2001) Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas—initial success and long-term results. Radiology 218:711–718
Miyayama S, Matsui O, Taki K et al (2005) Occluded Brescia-Cimino hemodialysis fistulas: endovascular treatment with both brachial arterial and venous access using the pull-through technique. CardioVasc Interv Radiol 28:806–812
Liang HL, Pan HB, Chung HM et al (2002) Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty. Radiology 223:339–344
Lay JP, Ashleigh RJ, Tranconi L et al (1998) Result of angioplasty of Brescia-Cimino haemodialysis fistulae: medium-term follow-up. Clin Radiol 53:608–611
Zaleski GX, Funaki B, Kenney S et al (1999) Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas [see comment]. J Vasc Interv Radiol 10:129–136
Kim BM, Goo DE, Park SI (2007) Bidirectional angioplasty with single vascular access in autogenous arteriovenous fistula. J Vasc Interv Radiol 18:868–874
Basile A, Medina JG, Lupattelli T et al (2004) Internal jugular vein access for the interventional management of nonfunctioning artero-venous haemodialysis fistulas. Eur J Radiol 52:288–292
Brescia MJ, Cimino JE, Appel K et al (1966) Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 275:1089–1092
Maeda K, Furukawa A, Yamasaki M et al (2005) Percutaneous transluminal angioplasty for Brescia-Cimino hemodialysis fistula dysfunction: technical success rate, patency rate and factors that influence the results. Eur J Radiol 54:426–430
Bohndorf K, Gunther RW, Vorwerk D et al (1990) Technical aspects and results of percutaneous transluminal angioplasty in Brescia-Cimino dialysis fistulas. CardioVasc Interv Radiol 13:323–326
Campeau L (1989) Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diag 16:3–7
Wu CJ, Hung WC, Chen SM et al (2005) Feasibility and safety of transradial artery approach for selective cerebral angiography. Cathet Cardiovasc Interv 66:21–26
Yip HK, Youssef AA, Chang WN et al (2007) Feasibility and safety of transradial arterial approach for simultaneous right and left vertebral artery angiographic studies and stenting. CardioVasc Interv Radiol 30:840–846
Yip HK, Chen MC, Chang HW et al (2004) Transradial application of PercuSurge Guard Wire device during primary percutaneous intervention of infarct-related artery with high-burden thrombus formation. Cathet Cardiovasc Interv 61:503–511
Wu CJ, Lo PH, Chang KC et al (1997) Transradial coronary angiography and angioplasty in Chinese patients. Cathet Cardiovasc Diag 40:159–163
Kawarada O, Yokoi Y, Nakata S et al (2006) Transradial intervention for native fistula failure. Cathet Cardiovasc Interv 68:513–520
Saito S (2006) Beyond coronary intervention. Cathet Cardiovasc Interv 68:521
Wang HJ, Yang YF (2006) Percutaneous treatment of dysfunctional Brescia-Cimino fistulae through a radial arterial approach. Am J Kidney Dis 48:652–658
Group Hemodialysis Adequacy Work (2006) Clinical practice guidelines for vascular access. Am J Kidney Dis 48:S248–S273
Koseoglu K, Akar H, Cildag B et al (2004) Resistive index measurement of native hemodialysis arteriovenous fistula feeding artery as a predictor for fistula dysfunction. ASAIO J 50(6):577–580
Kiemeneij F, Laarman GJ, Odekerken D et al (1997) A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol 29:1269–1275
Stella PR, Kiemeneij F, Laarman GJ et al (1997) Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. Cathet Cardiovasc Diag 40:156–158
Trerotola SO, Turmel-Rodrigues LA (2001) Off the beaten path: transbrachial approach for native fistula interventions. Radiology 218:617–619
Turmel-Rodrigues LA (2000) Hemodialysis access declotting: a native fistula is not a prosthetic graft. J Vasc Interv Radiol 11:135–137
Gmelin E, Winterhoff R, Rinast E (1989) Insufficient hemodialysis access fistulas: late results of treatment with percutaneous balloon angioplasty. Radiology 171:657–660
Hunter DW, So SK, Castaneda-Zuniga WR et al (1983) Failing or thrombosed Brescia-Cimino arteriovenous dialysis fistulas. Angiographic evaluation and percutaneous transluminal angioplasty. Radiology 149:105–109
Wu CC, Wen SC, Chen MK et al (2009) Radial artery approach for endovascular salvage of occluded autogenous radial-cephalic fistulae. Nephrol Dial Transplant [Epub ahead of print]
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Chen, SM., Hang, CL., Yip, HK. et al. Outcomes of Interventions Via a Transradial Approach for Dysfunctional Brescia-Cimino Fistulas. Cardiovasc Intervent Radiol 32, 952–959 (2009). https://doi.org/10.1007/s00270-009-9625-4
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DOI: https://doi.org/10.1007/s00270-009-9625-4