An ode to Cimino

The aim of the study was to ascertain whether a Cimino First policy can be implemented successfully in tertiary practice using a standardized technique.

This is a retrospective study. All first radial-cephalic (Cimino) fistulas placed by a single surgeon in incident patients were studied. A standardized surgical technique was used paying attention to the dorsal cephalic branch. No balloon maturation or early surveillance was performed. Kaplan-Meier survival analysis using survfit function in R (Vienna) was applied.

Fifty-seven (69%) of 83 new accesses were radial cephalic fistulas. Of these, 44 (77.2%) were men. The patients were aged 17 to 83 (mean 54.1; SD 14.6) years. Whites comprised of 21 (36.8%), maori 18 (31.6%), and pacific islanders 16 (28.1%). Comorbidities included diabetes in 32 (56.1%), hypertension in 47 (82.5%), and hyperlipidemia in 25 (46.3%; n=54). Twenty-six (45.6%) were pre-dialysis. Mean body mass index was 30.74 (SD 6.9) Kg/m² (n=56). Mean vein diameter was 3.3 mm (range 2.1-6.2 mm; n=36). Twenty-six (45.6%) had had previous central lines. Forty-four (77.2%) fistulas matured. Mean maturation time was 14.0 weeks. Thirty-six (63.2%) were used for dialysis while eight patients remained pre-dialysis with patent fistulas. Primary patency at one year and 18 months was 69.2% and 57.4% respectively. The figures for assisted primary patency were 85.6% and 72.3% respectively. Secondary patency was 87.6% and 83.9% at one and two years.

Cimino fistulas can be performed in a majority of patients with good results using a standardized surgical technique. The importance of the dorsal cephalic branch needs to be studied.