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Does pre-operative duplex examination improve patency rates of Brescia-Cimino fistulas?

A well-functioning vascular access remains the lifeline for patients with end-stage renal failure, who are being treated by chronic haemodialysis. Since 1966, the radiocephalic arteriovenous (AV) fistula, initially described by Brescia and Cimino, has been employed as a vascular access in many dialysis patients [1]. The Brescia-Cimino AV fistula has a low rate of complications and a high patency rate. Usually, the successful creation of this type of AV fistula depends on the quality and diameter of the radial artery and cephalic vein at the level of the wrist. Before the AV fistula actually can be punctured and is able to deliver a sufficient amount of blood to the artificial kidney, a certain period of time (usually 3-6 weeks) is needed for so-called fistula maturation. During this time period, a substantial increase in blood flow and vessel dilatation must occur. The chance of a successful maturation is difficult to predict and depends on the ability of the arterial and venous vessels to dilate under the influence of the increased shear rates (vessel remodelling). Major negative factors determining vessel quality are diabetes mellitus, older age and also the number of previous infusions, which may harm cephalic vein continuity.