A pioneering physician looks back on one of the most important achievements of his life. Cimino, MD, one recent morning, glancing down at his Mickey Mouse watch to make sure he was on schedule. Although he officially retired from his position as director of the Palliative Care Institute at CalvaryHospital in the Bronx in , Dr. Cimino, 78, is lively, engaged, and continues to meet regularly with medical students and work on special projects. Quite simply, we wanted to learn about the person who was responsible for one of the most important treatment advances in the history of dialysis: the Cimino-Brescia arteriovenous AV fistula. Developed 40 years ago by Dr.
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Autologous arteriovenous fistula is gold standard to maintain vascular access for hemodialysis patients. As per the Kidney Disease Outcomes Quality Initiative guidelines, distal veins are preferred as the first choice. In this study, a total of patients and fistulas were evaluated from April to March Demographic factors and clinical factors were taken into consideration.
Our study showed that age, sex, diabetes, and type of construction end-to-side vs. Intradialytic hypotension was one of the risk factors for loss of fistula patency. Primary failure was more with distal fistulas Navuluri R, Regalado S.
Semin Intervent Radiol ; Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clin J Am Soc Nephrol ; Changes in the practice of angioaccess surgery: Impact of dialysis outcome and quality initiative recommendations. J Vasc Surg ; The snuffbox arteriovenous fistula for vascular access. Eur J Vasc Endovasc Surg ; Predictors of early vascular-access failure in patients on hemodialysis. Saudi J Kidney Dis Transpl ; Klabunde RE.
Cardiovascular Physiology Concepts. USA; Radiocephalic wrist arteriovenous fistula for hemodialysis: Meta-analysis indicates a high primary failure rate. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol ; Factors responsible for fistula failure in hemodialysis patients. Pak J Med Sci ; Early arteriovenous fistula failure: A logical proposal for when and how to intervene.
Zangan SM, Falk A. Optimizing arteriovenous fistula maturation. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg ; Long and short term patency of radiocephalic arteriovenous fistulas.
Acta Chir Scand ; Preoperative radial arterial diameter predicts early failure of arteriovenous fistula AVF for haemodialysis. A prospective study of end-to-side vs. Br J Surg ; Search Article. Factors influencing patency of Brescia-Cimino arteriovenous fistulas in hemodialysis patients.
[The Stenosed Brescia-Cimino Fistula: Operation or Intervention?]
The survival of patients on long-term hemodialysis has improved. End-stage renal disease patients now need maintenance of their vascular access for much longer periods. Arteriovenous fistulae formed at the wrist are the first choice for this purpose, but, in many patients, these fistulae fail over time or are not feasible because of thrombosed veins. We searched the Pubmed database to evaluate the various options of vascular access in this group of patients based on the published literature. It is quite evident that, whenever possible, autogenous fistulae should be preferred over prosthetic grafts.
A Cimino fistula , also Cimino-Brescia fistula , surgically created arteriovenous fistula and less precisely arteriovenous fistula often abbreviated AV fistula or AVF , is a type of vascular access for hemodialysis. It is typically a surgically created connection between an artery and a vein in the arm, although there have been acquired arteriovenous fistulas which do not in fact demonstrate connection to an artery. The procedure was invented by doctors James Cimino and M. Brescia in Between treatments, the needles were left in place and the tube allowed blood flow to reduce clotting. But Scribner shunts lasted only a few days to weeks.
A Milestone in Hemodialysis: James E. Cimino, MD, and the Development of the AV Fistula
Introduction: Stenosis of the vein close to the arteriovenous anastomosis is the most frequent cause for late failure of Brescia-Cimino fistulae BCF. Although since decades proximal re-anastomosis has been regarded as the surgical standard treatment, success rates can hardly be deducted from the literature. Considering the increasing activities of interventional radiologists surgical position finding seems necessary. Methods: Over three years 30 anastomotic BCF stenoses were treated in 28 patients.