A Prospective Randomized Study Comparing the use of Plain PTA Balloon Catheters for Primary Balloon Angioplasty (PBA) Versus Hydrostatic Dilatation to Prepare the Cephalic Vein Prior to Creation of Radio-Cephalic Arteriovenous for Dialysis

Abstract

Introduction: Most of patients in Egypt with end stage renal disease (ESRD) are on hemodialysis because of the low rate of kidney transplantation due to legal, religious, and financial issues. While in the United States, it is estimated that 65% of ESRD patients were on hemodialysis, 30% underwent transplantation, and 5% on peritoneal dialysis. That is why maintenance of the hemodialysis access is of utmost importance because most of hospital admissions or ESRD patients is due to access site complications. Therefore, creating a natural functioning arteriovenous fistula is a top priority in our practice. Native arteriovenous fistulas are recommended but on the other hand these types of fistula fail to mature at higher rates than do arteriovenous grafts. For native arteriovenous fistula, the KDOQI guidelines identified a fully mature arteriovenous fistula suitable for cannulation by the rule of 6s, which include a 6 mm diameter vein, 6mm access depth from skin, with an access flow rate of 600ml/min. Methods: Fifty-seven (57) patients with ESRD in need for vascular access for whom a radio-cephalic arteriovenous fistula was of choice, with a cephalic vein ≤ 3 mm. They presented to us from the period of November 2014 till January 2017, were randomized into two groups. The cephalic vein was prepared in group (A) using hydrostatic dilatation prior to creation of the fistula, while in group (B) the vein was prepared using a PTA balloon catheter for primary balloon angioplasty prior to the creation of the fistula. Results: The technical success rate was 96.5%, 100% in both groups respectively. The reintervention rate was 35.7%, 7.1% in both groups respectively. The mean maturation time was 43days , 32.1 days in both groups respectively. Conclusion: Using primary balloon dilatation during creation of a radiocephalic arteriovenous fistula leads to a decreased maturation time and less reintervention rate, but still these results are statistically insignificant may be due to small number of study sample. Disclosure: Nothing to disclose