Salvaging and maintaining non-maturing Brescia–Cimino haemodialysis fistulae by percutaneous intervention

Nonmaturation of arm arteriovenous fistulas for hemodialysis access: A systematic review of risk factors and results of early treatment

“…Of these, 37 were excluded based on previously described criteria, and 33 studies were selected for final inclusion. These were 12 treatment papers [14][15][16][17][18][19][20][21][22][23][24][25] and eight preclinical articles, 9,[26][27][28][29][30][31][32] of which seven more were discarded after critical appraisal. So, one preclinical study finally remained (this is explained further subsequently).…”

“…25 Overall, 85.5% of treated patients (range, 74%-98%) were able to use their AVF at least once for hemodialysis after treatment. Six articles reported an average 1-year primary patency of 51% (range, 28%-68%), 14,15,[17][18][19][20] and seven reported an average 1-year secondary patency of 76% (range, 72%-95%). 14,15,[17][18][19]21,23 Eight articles specified complications for 508 patients.…”

“…Six articles reported an average 1-year primary patency of 51% (range, 28%-68%), 14,15,[17][18][19][20] and seven reported an average 1-year secondary patency of 76% (range, 72%-95%). 14,15,[17][18][19]21,23 Eight articles specified complications for 508 patients. [14][15][16][17][18][19][20]22 Overall, complications occurred in 47 patients (9.3%).…”

Low-flow maturation failure of distal accesses: Treatment by angioplasty of forearm arteries

“…They are associated with a higher risk of distal ischemia, 2,5-8-15 they cause more cardiac failure because of their higher flow, especially in patients with decreased cardiac reserve 3 ; they lead to a large decrease in venous pool because the entire cephalic and basilic vein in the forearm are lost, and they require more secondary procedures to maintain patency. 5 Primary patency of distal accesses that failed to develop was much better after PTA of forearm arteries, 83% (IQR, 60%-93%) at 1 year and 74% (IQR, 47%-89%) at 2 years, than reported primary access patency after PTA of access venous lesions of 28% at 1 year for Song et al 13 and 39% for Turmel-Rodrigues, et al 12 Although forearm arteries have a small diameter, the lesions are often long. Most of our patients had diabetes mellitus, the restenosis rate was low, and stenting appeared unnecessary.…”

“…10 Falk 11 reported nine cases of inflow artery angioplasty for nonmaturing fistulas but did not specify whether the PTA was of forearm or of more proximal arteries, except for one, a radial artery dilatation complicated of rupture. The only two other reported cases of radial artery PTA for nonmaturating access are by TurmelRodrigues et al 12 and Song et al, 13 who performed PTA at the same time for radial artery and venous stenosis in failing accesses. Arterial rupture is certainly a complication to fear after such an approach.…”