Figure 53

The Brescia-Cimino (radial-cephalic) fistula. The radial-cephalic fistula offers many advantages. It is simple to create and preserves more proximal vessels for future access construction. The lower incidence of steal is likely the result of the lower flow rate associated with these accesses. Additionally, such accesses have low rates of thrombosis and infection. The photograph shows a mature Brescia-Cimino fistula in a patient with longstanding diabetes. The fistula outflow vein has numerous aneurysmal segments, and, although they are associated with some tendency toward flow stagnation, they are of no harm to the patient's dialysis life. They do, however, become obvious targets for the dialysis technical staff, who have a tendency to puncture them repeatedly rather than to utilize new needle insertion sites. The patients arm also demonstrates marked muscle atrophy secondary to advanced diabetic neuropathy, which particularly involves the thenar eminence and the interosseus muscle groups. Complaints of weakness and loss of grip strength in the arm are common and may represent symptoms of steal. In this case, however, the symptoms are due to the intrinsic loss of muscle mass, rather than to steal.

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