title: Percutaneous dilation of the radial artery in nonmaturing autogenous radial-cephalic fistulas for haemodialysis.
abstract: BACKGROUND
  Delayed maturation of radial-cephalic fistulas can be due to lesions of the radial artery that are amenable to percutaneous dilation.
  
  
  METHODS
  Over a period of 7 years, 74 consecutive patients underwent angiography of an immature fistula that showed either stenosis or an insufficient enlargement of the radial artery that was treated by percutaneous dilation. Success, complications and secondary interventions were recorded according to consensus definitions. Patency following angioplasty was estimated with the Kaplan-Meier technique.
  
  
  RESULTS
  The mean patient age was 70 years, 44% were women, 69% had diabetes, 23% were smokers, 76% had hypertension, 64% had coronary disease and 46% had peripheral artery occlusive disease. Concomitant venous stenosis was diagnosed in 53% of patients. Arterial stenosis was >5 cm long in 53 cases. Technical success was achieved in 73/74 cases following angioplasty. All but two fistulas were then successfully used for dialysis. Dilation-induced rupture occurred in 13 cases (17%) but required only two stent placements. Five cases (7%) of hand ischaemia within 1 month of dilation were treated successfully by ligation of the distal artery. Primary patency rates at 12 and 24 months were significantly better for pure arterial lesions, with 65% and 61% compared to 42% and 35% in cases of concomitant venous stenosis (P < 0.04). The secondary patency rates were 96% and 94% at 1 and 2 years, respectively.
  
  
  CONCLUSIONS
  Dilation of the radial artery yields higher patency rates than for veins. Surgeons might therefore be less demanding about the initial quality of the radial artery prior to creation of radial-cephalic fistulas.
authors: Department of Cardiovascular Radiology, Clinique St-Gatien, 8 place de Cathédrale, 37000 Tours, France. luc.turmel@wanadoo.fr
authors: Luc
authors: L
authors: Turmel-Rodrigues
authors: Jean-Michel
authors: JM
authors: Boutin
authors: Christophe
authors: C
authors: Camiade
authors: Georges
authors: G
authors: Brillet
authors: Mahammed
authors: M
authors: Fodil-Chérif
authors: Albert
authors: A
authors: Mouton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery*; D006435:Renal Dialysis; D014654:Vascular Patency; D055815:Young Adult