[The stenosed Brescia-Cimino fistula: operation or intervention?].
BACKGROUND
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.


RESULTS
Procedural success rate was 100%. 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 (0.03 per patient-year). 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 0.3 per patient-year, and primary (secondary) patency was 80% (95%) at one year and 67% (87%) at two years.


CONCLUSIONS
In BCF proximal re-anastomosis is a simple and effective therapeutic option for anastomotic venous stenosis. Re-intervention rates are low and procedural success rates as well as primary and secondary patency rates at least equal those of interventional radiology.
Mickley
V
V
Fachbereich Gefässchirurgie der Stadtklinik Baden-Baden. v.mickley@stadtklinik-baden.de
Cazzonelli
M
M
Bossinger
A
A
D015901:Angiography, Digital Subtraction; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017534:Radial Artery / Q000601:surgery; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000295:instrumentation*; D012086:Reoperation; D013997:Time Factors; D014654:Vascular Patency