Cimino fistula
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[[Image:Fistula.gif|thumb|An AV fistula.]]
A '''Cimino fistula''', also '''Cimino-Brescia fistula''' and '''arteriovenous fistula''', is a type of vascular access for [[hemodialysis]]. It is a surgically created connection between an [[artery]] and a [[vein]] in the forearm.
==Theoretical basis==
AV fistulas work effectively because they:
* Have high [[volume flow rate]]s (as blood takes the path of least resistance; it prefers the (low resistance) AV fistula over traversing (high resistance) capillary beds).
* Native blood vessels, when compared to synthetic grafts,<ref>Konner K. Vascular access in the 21st century. J Nephrol. 2002 Nov-Dec;15 Suppl 6:S28-32. PMID 12515371.</ref> are less likely to develop [[stenosis|stenoses]] and fail.
==History==
The procedure was invented by doctors Cimino and Brescia in 1966.<ref>Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula.
N Engl J Med. 1966 Nov 17;275(20):1089-92. PMID 5923023.</ref> Before the Cimino fistula was invented, access was through a [[Scribner shunt]], which consisted of a [[Teflon]] tube with a needle at each end. 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. Frustrated by this limitation, [[Dr. James Cimino]] recalled his days as a [[phlebotomist]] (blood drawer) at [[New York City]]'s [[Bellevue Hospital]] in the 1950s when [[Korean War]] [[veteran]]s showed up with [[arteriovenous fistula|fistulas]] caused by trauma. Cimino recognized that these fistulas did not cause the patients harm and were easy places to get repeated blood samples. He convinced surgeon Kenneth Appel to create some in patients with [[chronic renal failure|chronic kidney failure]] and the result was a complete success. Scribner shunts were quickly replaced with Cimino fistulas, and 40 years later, they are still the most effective, longest-lasting method for long-term access to patients' blood for dialysis.
==References==
<references/>
==See also==
*[[Arteriovenous fistula]]
[[Category:Vascular surgery]]
[[Category:Renal dialysis]]
[[de:Cimino-Shunt]]
[[es:FĂstula de Cimino]]