Brachial Arterial Access: Endovascular Treatment of Failing Brescia-Cimino Hemodialysis Fistulas—Initial Success and Long-Term Results

PURPOSE: To evaluate safety and efficacy of endovascular interventions in failing antebrachial Brescia-Cimino hemodialysis fistulas in consecutive patients. MATERIALS AND METHODS: Altogether, 103 interventions were performed in 53 Brescia-Cimino shunts in 51 patients by means of antegrade brachial arterial access. Twelve interventions were initiated with pharmacomechanical thrombolysis and/or thromboaspiration. All interventions included balloon angioplasty that was completed with stent placement in eight cases and with endovascular brachytherapy with an iridium 192 source in five cases. RESULTS: The technical success rate of the primary interventions was 92% (49 of 53) and that for all interventions was 95% (98 of 103). The rate of major complications was 4% (four of 103). Clinical success was achieved in 92% (95 of 103) of the interventions. By including the initial failures, 58% ± 7 (standard error of the estimate), 44% ± 8, 40% ± 8, and 32% ± 10 primary and 90% ± 5, 85% ± 5, 79% ± 7, and 79% ± 7 secon...