Percutaneous treatment of dysfunctional Brescia-Cimino fistulae through a radial arterial approach.
BACKGROUND
Dysfunctional Brescia-Cimino fistulae contribute to significant morbidity in hemodialysis patients. These fistulae normally are treated through a retrograde venous approach. There are no data regarding a transradial approach. Furthermore, measurement of pressure reduction in the radial artery appears to be useful.


METHODS
We retrospectively examined 50 interventions to treat 49 patients (17 men, 32 women; mean age, 61.8 +/- 10.6 years) with Brescia-Cimino fistulae. Inclusion criteria were patients with palpable radial arteries and dysfunctional end-to-side Brescia-Cimino fistulae. Patients with infected fistulae, contrast allergy, upper-arm/synthetic graft/central-vein stenosis, and end-to-end Brescia-Cimino fistulae were excluded from the study. Radial arterial pressures before and after angioplasty were compared as a surrogate of stenosis relief. Anatomic and clinical success rates were calculated.


RESULTS
Sixty-five stenoses and 4 total occlusions were treated through radial access. All radial punctures were successful, except in 1 patient. Most lesions were located in the cephalic vein (87%). Mean length of treated lesions was 4.1 +/- 2.8 cm. Mean pretreatment diameter of lesion stenoses was 76.7% +/- 12.1%. Mean posttreatment diameter stenosis was 22.6% +/- 8.2% (P < 0.001). Systolic, diastolic, and mean blood pressures recorded from the radial artery decreased from 130 +/- 40, 60 +/- 18, and 87 +/- 27 to 88 +/- 40, 43 +/- 18, and 60 +/- 26 mm Hg (P < 0.001, P < 0.001, and P < 0.001), respectively. The anatomic success rate of the transradial approach was 91.3%. The clinical success rate of the transradial approach was 96%.


CONCLUSIONS
The transradial approach is a feasible and highly effective approach to treat dysfunctional Brescia-Cimino fistulae. Measuring blood pressure reduction through the radial artery appears promising as a hemodynamic evaluation method.
Wang
Huang-Joe
HJ
Department of Internal Medicine, Division of Cardiology, China Medical University Hospital, Taichung, Taiwan. joe5977@ms32.hinet.net
Yang
Ya-Fei
YF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001794:Blood Pressure / Q000502:physiology; D003251:Constriction, Pathologic / Q000628:therapy; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome