Cimino fistula

A Cimino shunt, or also Cimino -Brescia fistula is a surgically created direct connection of an artery (usually radial artery ) and a lying next to or near the vein ( usually cephalic or median cubital vein ). Use of this shunt is in chronic dialysis treatment in which the patient can be connected via this shunt to the external blood filter machines.

Surgical Procedure

Most common site for installation of the shunt is the distal, ie, distal forearm. Before surgery, the vessels of both sides are Doppler sonography reviewed and issued a recommendation.

Access to the vessels via a skin incision of 3-5 cm on the thumb- side forearm end. Then first the vein will be investigated and presented and then dissected the artery. The vein must be solved as far from the connective tissue surrounding them, that they may be laid without tension to the artery. Then clamped to the vein from cuts them off at the distal end and flushes it with a heparin - saline. Then we caught from the artery and opens it with a short longitudinal section. The vein is then possible, without rotational error, that is, without rotating around its own axis of the vein to -side anastomosis in an end sewn to the artery, then the terminals of the containers are released. The vein should fill with arterial blood now, what can be observed by a significant increase in lumen. Using your finger, you can feel a pulsating buzz. The anastomosis has to be checked for possible leakage. Finally, sew the skin is cut again and listens with a stethoscope still operated the site from. It should be able to hear a pulse-synchronous twang.

Complications

In addition to errors in the operation itself, such as a rotational error, there may be closures of the shunt and anastomotic leaks also cause infections of the Shuntgebietes, thrombotic. Also a strong elongation of the vein towards the upper arm, an aneurysm happens.