Staged Angioplasty Using a Full-length Balloon Catheter to Achieve Maturation of Arteriovenous Fistulas

Overview

Journal Diagn Interv Radiol

Publisher Galenos Publishing House

Date 2024 May 13

PMID 38738746

Authors

Miju Bae

Chang Ho Jeon

Sung Woon Chung

Chung Won Lee

Up Huh

Jongwon Kim

Hyuncheol Jeong

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure.

Methods: This study included patients who underwent AVF surgery using an autogenous vein between February 2020 and June 2021 and received staged angioplasty with a full-length balloon catheter. To minimize balloon overlap and the risk of barotrauma to the immature vein, serial-staged upsizing balloon angioplasty with a long balloon catheter covering the entire vein segment was employed approximately 2 weeks apart.

Results: Twenty-three patients (mean age, 69.50 years; mean follow-up, 620.62 days) with average diameters of the radial artery and cephalic vein at 2.14 ± 0.5 mm and 2.43 ± 0.5 mm, respectively, were enrolled. In the first procedure, the average AVF diameter and flow were 4.03 ± 0.57 mm and 438.08 ± 220.95 mL/min, respectively, with juxta-anastomotic stenosis (JAS) present in 61.5% of cases. After staged full-length BAM, the average fistula diameter and flow improved to 5.95 ± 0.86 mm and 717.52 ± 305.95 mL/min, respectively. Maturation was achieved in 87% of the cases. No hematomas or ruptures occurred around the arterialized veins. Despite successful maturation and cannulation, 65.2% of the patients required additional percutaneous transluminal angioplasty (PTA) during the follow-up period. The necessity for PTA was determined by the presence of JAS prior to the first staged full-length BAM, with an odds ratio of 11.74 (95% confidence interval: 1.31-104.96, = 0.03).

Conclusion: Staged full-length BAM can be safely used in patients with small veins requiring further maturation. Most patients achieved successful cannulation following maturation without post-procedural complications.

Clinical Significance: Staged full-length BAM is a safe and effective method for enhancing maturation in patients with underdeveloped small veins.

References

Harduin L, Guerra J, Virgini-Magalhaes C, da Costa F, Vieira B, Mello R . Oversized balloon angioplasty for endovascular maturation of arteriovenous fistulae to accelerate cannulation and to decrease the duration of catheter use. J Vasc Access. 2021; 24(2):238-245. DOI: 10.1177/11297298211029558. View

Rezapour M, Sepehri M, Khavanin Zadeh M, Alborzi M . A new method to determine anastomosis angle configuration for arteriovenous fistula maturation. Med J Islam Repub Iran. 2019; 32:62. PMC: 6325282. DOI: 10.14196/mjiri.32.62. View

Shembekar S, Zodpe D, Padole P . Prediction of the anastomosis angle of arteriovenous fistula in hemodialysis to standardize the surgical technique. Biomed Mater Eng. 2022; 33(5):423-436. DOI: 10.3233/BME-211389. View

Kao T, Hsieh H, Yu S, Su T, Ko P . Long-term efficacy and risk factors of balloon-assisted maturation for radial-cephalic arteriovenous fistula with small-caliber veins. Hemodial Int. 2023; 27(3):241-248. DOI: 10.1111/hdi.13091. View

Park S, Ko S, Kim J, Moon I, Kim S . Balloon-assisted maturation for arteriovenous fistula maturation failure: an early period experience. Ann Surg Treat Res. 2016; 90(5):272-8. PMC: 4865705. DOI: 10.4174/astr.2016.90.5.272. View

Park H, Lee Y, Kim H, Baik J, Won Y, Park C . Usefulness of assisted procedures for arteriovenous fistula maturation without compromising access patency. Hemodial Int. 2016; 21(3):335-342. DOI: 10.1111/hdi.12499. View

Tordoir J, Zonnebeld N, van Loon M, Gallieni M, Hollenbeck M . Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence. Eur J Vasc Endovasc Surg. 2018; 55(2):240-248. DOI: 10.1016/j.ejvs.2017.12.001. View

Elkassaby M, Elsaadany N, Mowaphy K, Soliman M . Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study. Vascular. 2020; 29(5):776-783. DOI: 10.1177/1708538120979872. View

Kim H, Han A, Ahn S, Ko H, Chung C, Choi K . Better Efficacy of Balloon Assisted Maturation in Radial-Cephalic Arteriovenous Fistula for Hemodialysis. Vasc Specialist Int. 2021; 37(1):29-36. PMC: 8021496. DOI: 10.5758/vsi.210003. View

10.

Thomas S, Sideris A, Narroway H, McLachlan R, Robertson C, Crowe P . Arteriovenous fistula formation with adjuvant endovascular maturation. J Vasc Surg. 2021; 75(2):641-650.e2. DOI: 10.1016/j.jvs.2021.08.072. View

11.

Meng L, Zhang T, Ho P . Effect of exercises on the maturation of newly created arteriovenous fistulas over distal and proximal upper limb: A systematic review and meta-analysis. J Vasc Access. 2022; 25(1):40-50. DOI: 10.1177/11297298221100446. View

12.

Abreo K, Buffington M, Sachdeva B . Angioplasty to promote arteriovenous fistula maturation and maintenance. J Vasc Access. 2018; 19(4):337-340. DOI: 10.1177/1129729818760979. View

13.

Nauwelaers S, Lansink W, Schroe H, Lauwers G . Surgical rejoining of small arm veins to enhance dialysis fistula maturation. J Vasc Access. 2019; 21(1):105-109. DOI: 10.1177/1129729819860350. View

14.

Lee S, Jeon G, Lee B, Lee G, Lee J . Endovascular management in immature arteriovenous fistula for hemodialysis. Medicine (Baltimore). 2018; 97(36):e12211. PMC: 6133470. DOI: 10.1097/MD.0000000000012211. View

15.

Roy-Chaudhury P, Lee T, Woodle B, Wadehra D, Campos-Naciff B, Munda R . Balloon-assisted maturation (BAM) of the arteriovenous fistula: the good, the bad, and the ugly. Semin Nephrol. 2012; 32(6):558-63. PMC: 4309013. DOI: 10.1016/j.semnephrol.2012.10.007. View

16.

Kanchanasuttirak P, Pitaksantayothin W, Saengprakai W, Kanchanabat B . Systematic review and meta-analysis: Efficacy and safety of balloon angioplasty in salvaging non-matured arteriovenous fistulas. J Vasc Access. 2022; 24(6):1244-1252. DOI: 10.1177/11297298221085440. View

17.

Li Y, Li Y, Yu S, Kao T, Ko P, Wei W . The clinical outcome of balloon-assisted maturation procedure between autogenous radiocephalic fistula and brachiocephalic fistula in a single-center experience. J Vasc Surg. 2022; 76(4):1060-1065. DOI: 10.1016/j.jvs.2022.04.037. View

18.

Vachharajani T, Hassanein M, Liaqat A, Haddad N . Vessel Preservation in Chronic Kidney Disease. Adv Chronic Kidney Dis. 2020; 27(3):177-182. DOI: 10.1053/j.ackd.2020.03.006. View

19.

DerDerian T, Hingorani A, Boniviscage P, Carollo A, Ascher E . Acute complications after balloon-assisted maturation. Ann Vasc Surg. 2014; 28(5):1275-9. DOI: 10.1016/j.avsg.2013.12.030. View

20.

Huang H, Hsu C, Kang M . Does the balloon-assisted maturation procedure offer comparable results for AVF created with a smaller vein?. J Vasc Access. 2023; 25(4):1108-1113. DOI: 10.1177/11297298221150665. View