title: Outcomes of interventions via a transradial approach for dysfunctional Brescia-Cimino fistulas.
abstract: The transradial artery approach to angioplasty has rarely been reported as a method for treating dysfunctional Brescia-Cimino fistulas. This study evaluated the feasibility, safety, and 1-year efficacy of this method for treating dysfunctional Brescia-Cimino fistulas. We retrospectively evaluated 154 consecutive procedures in 131 patients (age, 58.3 +/- 11.6 years; male, 48.1%) who underwent the transradial approach in dysfunctional Brescia-Cimino fistulas in the 1-year period after the procedure. The operator determined the use of a regular or a cutting balloon (two cases) in combination with urokinase injection (one case) or catheter thromboaspiration. Radial artery puncture was successful in all cases. Fifty-two cases (33.8%) had totally occluded fibrotic lesions. The overall anatomic success rate and clinical success rate were 61% (94/154) and 81.1% (125/154), respectively. In cases with a totally occluded fibrotic lesion, the clinical success rate was 46%. Successful intervention was associated with a significant reduction in the radial arterial systolic and diastolic pressures. There were no complications of symptomatic arterial embolization or pulmonary embolism, and one complication of venous rupture was successfully treated by compression. The primary patency rates based on intention-to-treat were 75.3% at 30 days and 39.0% at 1 year after the procedure. Excluding the cases with a totally occluded lesion, the clinical success rate was 99% (101/102) and the primary patency rates were 84.3% (86/102) and 52.0% (53/102) at 3 months and 1 year after the procedure, respectively. In conclusion, the transradial approach is a feasible, safe, and effective alternative for catheter intervention for dysfunctional Brescia-Cimino fistulas. Its success rate in cases with a totally occluded fibrotic lesion is unsatisfactory.
authors.affiliation: Division of Cardiology, Chang Gung Memorial Hospital-Kaoshiung Medical Center, Chang Gung University College of Medicine, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, ROC.
authors.forename: Shyh-Ming
authors.initials: SM
authors.lastname: Chen
authors.forename: Chi-Ling
authors.initials: CL
authors.lastname: Hang
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Fang
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Yang
authors.forename: Yuan-Kai
authors.initials: YK
authors.lastname: Hsieh
authors.forename: Gary Bih-Fang
authors.initials: GB
authors.lastname: Guo
mesh_terms: D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D003287:Contrast Media