The survival of patients on long-term hemodialysis has improved. End-stage renal disease patients now need maintenance of their vascular access for much longer periods. Arteriovenous fistulae formed at the wrist are the first choice for this purpose, but, in many patients, these fistulae fail over time or are not feasible because of thrombosed veins. We searched the Pubmed database to evaluate the various options of vascular access in this group of patients based on the published literature. It is quite evident that, whenever possible, autogenous fistulae should be preferred over prosthetic grafts.
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Introduction: Stenosis of the vein close to the arteriovenous anastomosis is the most frequent cause for late failure of Brescia-Cimino fistulae BCF. Although since decades proximal re-anastomosis has been regarded as the surgical standard treatment, success rates can hardly be deducted from the literature.
Considering the increasing activities of interventional radiologists surgical position finding seems necessary. Methods: Over three years 30 anastomotic BCF stenoses were treated in 28 patients. In 15 patients the stenosis had caused fistula thrombosis. In all cases the fistula vein was re-anastomosed to the proximal radial artery. All patients could be followed up average 12 months.
Each fistula functioning after 24 hours was classified as procedural success. For calculation of patency rates life table analysis , however, usability of the needling segment of the access was assessed.
One fistula thrombosed on the second postoperative day after a successful dialysis session due to an overlooked proximal stenosis of its feeding radial artery.
In five fistulae stenoses developed after 4 to 13 months. In only one fistula this was a true re-stenosis of the newly created anastomosis 0. Two of the stenoses occurred in the needling segment of the access vein and within its central venous outflow, respectively.
Overall re-intervention rate was 0. Conclusion: In BCF proximal re-anastomosis is a simple and effective therapeutic option for anastomotic venous stenosis.
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Save Cancel. Create a file for external citation management software Create file Cancel. Full-text links Cite Favorites. Abstract Introduction: Stenosis of the vein close to the arteriovenous anastomosis is the most frequent cause for late failure of Brescia-Cimino fistulae BCF.
Similar articles Is surgical thrombectomy to salvage failed autogenous arteriovenous fistulae worthwhile? Palmer RM, et al. Am Surg. PMID: Percutaneous treatment of dysfunctional Brescia-Cimino fistulae through a radial arterial approach. Wang HJ, et al. Am J Kidney Dis. The snuffbox arteriovenous fistula for vascular access. Wolowczyk L, et al. Eur J Vasc Endovasc Surg. Arteriovenous fistulae for hemodialysis. Burkhart HM, et al. Semin Vasc Surg. PMID: Review. Interventional radiology in hemodialysis fistulae and grafts: a multidisciplinary approach.
Turmel-Rodrigues L, et al. Cardiovasc Intervent Radiol. Epub Jan Show more similar articles See all similar articles. Cited by 2 articles Impaired maturation of distal radio-cephalic fistula for haemodialysis: a review of treatment options. Pirozzi N, et al.
J Nephrol. Epub Jul 7. Kubale R, et al. Publication types Comparative Study Actions. English Abstract Actions. Constriction, Pathologic Actions.
Female Actions. Follow-Up Studies Actions. Humans Actions. Male Actions. Radiography, Interventional Actions. Reoperation Actions. Time Factors Actions. Vascular Patency Actions. Copy Download.
Hemodialysis vascular access options after failed Brescia-Cimino arteriovenous fistula
Introduction: Stenosis of the vein close to the arteriovenous anastomosis is the most frequent cause for late failure of Brescia-Cimino fistulae BCF. Although since decades proximal re-anastomosis has been regarded as the surgical standard treatment, success rates can hardly be deducted from the literature. Considering the increasing activities of interventional radiologists surgical position finding seems necessary. Methods: Over three years 30 anastomotic BCF stenoses were treated in 28 patients. In 15 patients the stenosis had caused fistula thrombosis. In all cases the fistula vein was re-anastomosed to the proximal radial artery.
A Milestone in Hemodialysis: James E. Cimino, MD, and the Development of the AV Fistula
A pioneering physician looks back on one of the most important achievements of his life. Cimino, MD, one recent morning, glancing down at his Mickey Mouse watch to make sure he was on schedule. Although he officially retired from his position as director of the Palliative Care Institute at CalvaryHospital in the Bronx in , Dr. Cimino, 78, is lively, engaged, and continues to meet regularly with medical students and work on special projects. Quite simply, we wanted to learn about the person who was responsible for one of the most important treatment advances in the history of dialysis: the Cimino-Brescia arteriovenous AV fistula.
[The Stenosed Brescia-Cimino Fistula: Operation or Intervention?]
A Cimino fistula , also Cimino-Brescia fistula , surgically created arteriovenous fistula and less precisely arteriovenous fistula often abbreviated AV fistula or AVF , is a type of vascular access for hemodialysis. It is typically a surgically created connection between an artery and a vein in the arm, although there have been acquired arteriovenous fistulas which do not in fact demonstrate connection to an artery. The procedure was invented by doctors James Cimino and M. Brescia in Between treatments, the needles were left in place and the tube allowed blood flow to reduce clotting. But Scribner shunts lasted only a few days to weeks. Frustrated by this limitation, James E.