title: Occluded Brescia-cimino hemodialysis fistulas: endovascular treatment with both brachial arterial and venous access using the pull-through technique.
abstract: We retrospectively evaluated the usefulness of both arterial and venous access with the pull-through technique in endovascular treatment of totally occluded Brescia-Cimino fistulas. We treated 26 patients (17 men, 9 women; age range 43-82 years, mean age 66 years) with occluded Brescia-Cimino fistulas. First, the occluded segment was traversed from the antegrade brachial arterial access using a microcatheter-guidewire system. Second, the vein was retrogradely punctured after confirmation of all diseased segments, and a 0.014- or 0.016-inch guidewire was pulled through the venous access when the occluded segment was long. All interventions including thrombolysis, thromboaspiration, angioplasty, and stent placement were performed via the venous access. The occlusion was successfully crossed via the brachial arterial access in 23 patients (88%). In 2 patients it was done from the venous approach. In the remaining patient it was not possible to traverse the occluded segment. The pull-through technique was successful in all 19 attempts. Clinical success was achieved in 96%, the primary patency rates at 6, 12, and 18 months were 83%, 78%, and 69%, the primary assisted patency rates were 92%, 92%, and 72%, and the secondary patency rates were 92%, 92%, and 92%, respectively. Minor complications in 5 patients included venous perforation in 2 (8%), venous rupture in 1 (4%), and regional hematoma in 2 (8%). Our study suggests that endovascular treatments with both arterial and venous access using the pull-through technique are highly effective in restoring function in totally occluded Brescia-Cimino fistulas.
authors.affiliation: Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Fukui, 918-8503, Japan. s-miyayama@fukui.saiseikai.or.jp
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyayama
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Keiichi
authors.initials: K
authors.lastname: Taki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Minami
authors.forename: Rieko
authors.initials: R
authors.lastname: Shinmura
authors.forename: Chiharu
authors.initials: C
authors.lastname: Ito
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Takamatsu
authors.forename: Miki
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Yashuyuki
authors.initials: Y
authors.lastname: Ushiogi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001367:Axillary Vein / Q000000981:diagnostic imaging* / Q000601:surgery*; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology