Brachial arterial access: Endovascular treatment of failing Brescia-Ciminohemodialysis fistulas - Initial success and long-term results

PURPOSE: To evaluate safety and efficacy of endovascular interventions in f ailing antebrachial Brescia-Cimino hemodialysis fistulas in consecutive pat ients. MATERIALS AND METHODS: Altogether, 103 interventions were performed in 53 B rescia-Cimino shunts in 51 patients by means of antegrade brachial arterial access. Twelve interventions were initiated with pharmacomechanical thromb olysis and/or thromboaspiration. All interventions included balloon angiopl asty that was completed with stent placement in eight cases and with endova scular brachytherapy with an iridium 192 source in five cases. RESULTS: The technical success rate of the primary interventions was 92% (4 9 of 53) and that for all interventions was 95% (98 of 103). The rate of ma jor 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% +/- 1 0 primary and 90% +/- 5, 85% +/- 5, 79% +/- 7, and 79% +/- 7 secondary clin ical patency rates were registered at 6 months and 1, 2, and 3 years, respe ctively, by means of Kaplan-Meier analysis. The location of the main treate d lesion at the arteriovenous anastomosis (P = .03) was a predictor of poor er long-term patency. CONCLUSION: Endovascular interventions with antegrade brachial arterial acc ess are highly effective in restoring function in failing Brescia-Cimino fi stulas.