Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty.
OBJECTIVE
To evaluate the authors' experience with a technique for management of thrombosed Brescia-Cimino arteriovenous fistula.


METHODS
Forty patients with 42 thrombosed arteriovenous fistulas were percutaneously treated. Thrombosis occurred within 24 hours of attempted angioplasty in five fistulas, between 24 and 72 hours in 27, and longer than 72 hours in 10. Thrombosed fistulas were approached in a retrograde fashion followed by direct balloon dilation with 5-8-mm balloon catheters. If retrograde catheterization failed to cross the arterial anastomosis, an antegrade puncture directly into the thrombosed drainage vein close to the anastomosis was performed with ultrasonographic guidance, as an aid to catheterize the arterial inflow. Thrombolytic therapy with infusion of urokinase directly into the thrombus was performed in selected patients with visible thrombus that had compromised blood flow in the partially restored vascular access. Postintervention primary and secondary patency was calculated by using Kaplan-Meier analysis. Patency rates between patients without and with urokinase infusion were examined by using the log-rank test.


RESULTS
Anatomic success was achieved in 39 (93%) of 42 fistulas; and clinical patency, in 38 (90%) of 42 fistulas. Postintervention primary and secondary patencies (including initial technical failure) at 6, 12, and 18 months were 81% and 84%, 70% and 80%, and 63% and 80%, respectively. No significance of patency rate between patients without and with urokinase infusion was found (P =.912). Three patients died of unrelated causes at 1, 2, and 5 months after the procedures. No major complications were encountered.


CONCLUSIONS
High anatomic success and excellent clinical patency can be achieved in the salvage of thrombosed arteriovenous fistulas. Percutaneous restoration of arteriovenous fistulas should be attempted before surgical recreation to optimize outcome in patients undergoing hemodialysis.
Liang
Huei-Lung
HL
Department of Radiology, Kaohsiung Veterans General Hospital, National Yang-Ming University, 386 Ta-Chung 1st Rd, Kaohsiung, Taiwan 813, Republic of China.
Pan
Huay-Ben
HB
Chung
Hsiao-Min
HM
Ger
Luo-Ping
LP
Fang
Hua-Chang
HC
Wu
Tung-Ho
TH
Wu
Ming-Ting
MT
Lai
Ping-Hong
PH
Chen
Clement K-H
CK
Yang
Chien-Fang
CF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency