Percutaneous Treatment of Dysfunctional Brescia-Cimino Fistulae Through a Radial Arterial Approach

Abstract

Background: Dysfunctional Brescia-Cimino fistulae contribute to significant morbidity in hemodialysis patients. These fistulae normally are treated through a retrograde venous approach. There are no data regarding a transradial approach. Furthermore, measurement of pressure reduction in the radial artery appears to be useful. Methods: We retrospectively examined 50 interventions to treat 49 patients (17 men, 32 women; mean age, 61.8 ± 10.6 years) with Brescia-Cimino fistulae. Inclusion criteria were patients with palpable radial arteries and dysfunctional end-to-side Brescia-Cimino fistulae. Patients with infected fistulae, contrast allergy, upper-arm/synthetic graft/central-vein stenosis, and end-to-end Brescia-Cimino fistulae were excluded from the study. Radial arterial pressures before and after angioplasty were compared as a surrogate of stenosis relief. Anatomic and clinical success rates were calculated. Results: Sixty-five stenoses and 4 total occlusions were treated through radial access. All radial punctures were successful, except in 1 patient. Most lesions were located in the cephalic vein (87%). Mean length of treated lesions was 4.1 ± 2.8 cm. Mean pretreatment diameter of lesion stenoses was 76.7% ± 12.1%. Mean posttreatment diameter stenosis was 22.6% ± 8.2% (P < 0.001). Systolic, diastolic, and mean blood pressures recorded from the radial artery decreased from 130 ± 40, 60 ± 18, and 87 ± 27 to 88 ± 40, 43 ± 18, and 60 ± 26 mm Hg (P < 0.001, P < 0.001, and P < 0.001), respectively. The anatomic success rate of the transradial approach was 91.3%. The clinical success rate of the transradial approach was 96%. Conclusion: The transradial approach is a feasible and highly effective approach to treat dysfunctional Brescia-Cimino fistulae. Measuring blood pressure reduction through the radial artery appears promising as a hemodynamic evaluation method. © 2006 National Kidney Foundation, Inc.