Percutaneous angioplasty of arteriovenous (Brescia-Cimino) fistulae in children

Abstract

The development of a stenosis in a Brescia-Cimino fistula is a major clinical problem that threatens vascular access for dialysis. We reviewed the case notes of 46 children undergoing hemodialysis via Brescia-Cimino fistulae. Ten children (mean age 12.5 years) developed 14 stenoses located in the venous (10), anastomotic (3), or arterial (1) part of the fistula. Three (1 arterial and 2 anastomotic stenoses) of the 14 stenoses were treated surgically; the remaining 11 (10 venous and 1 anastomotic stenoses) were treated by angioplasty. Seventeen angioplasty procedures were performed by the percutaneous venous route under local anesthesia. Mean follow-up was 24 months. Restenosis within 6 months occurred in 5 patients, predominantly those who had angioplasty with low balloon inflation pressures; 1 was treated surgically; 4 underwent repeat angioplasty using higher balloon inflation pressures (3 patients) or a bigger balloon (1 patient). None subsequently developed restenosis. Angioplasty can be safely used to treat stenosis of arteriovenous fistulae, with a high initial (60% freedom from restenosis at 6 months) success rate. In summary, balloon angioplasty, repeated if necessary, is a safe and effective treatment for the majority of stenoses occurring in Brescia-Cimino fistulae. Restenosis can be safely treated by further angioplasty, which is associated with a high rate of ultimate clinical success.

Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae for hemodialysis

“…Other indicators are evidenced by alterations during hemodialysis, such as inefficacious dialysis, low blood flow, increase in the venous pressure, difficulty to obtain another venous access, increase in the time necessary to reach hemostasis after hemodialysis, increase in the intra-access pressure and signs of recirculation. Thus, when diagnosed, intervention is justified to maintain the patency of the vascular access and consequently reduce the incidence of hemodialysis failure due to loss of the fistula [ 3 , 6 , 7 ].…”

Detection of Dialysis Access Induced Limb Ischemia by Infrared Thermography in Children

“…Maturation of the fistula may be prolonged in children (for up to six months) requiring meticulous and early planning, as well as consistent monitoring of the progression of their chronic kidney disease. Possible complications of pediatric AV fistulae include primary non‐function, usually due to maturation failure or clotting, stenosis, which can develop anywhere along the fistula, thrombosis, and steal syndrome (3,5,11).…”