SS33. Low-Volume Flows After Balloon-Assisted Maturation Correlate With High Maturation Failures of Arteriovenous Fistulas

Abstract

Arteriovenous fistula (AVF) is the preferred modality for hemodialysis access, but nearly a third of created AVFs do not mature for successful cannulation. Most of the nonmaturing AVFs require a variety of adjunct procedures (APs) for maturation. The aim of this study was to evaluate the performance of balloon-assisted maturation (BAM) in achieving successful cannulation and to identify predicting factors of maturation after BAM. Patients undergoing BAM for AVF maturation between January 2015 and May 2017 were retrospectively studied. The primary end points were time to maturation and number of subsequent APs needed to achieve maturation. Secondary end points were patency rates after successful cannulation. Of 289 dialysis access creations performed during the study period, 39 AVFs in 37 patients (21 female; median age, 58 years) underwent BAM. They required a total of 66 APs (1.69 per AVF) with a 59% (23/39) maturation rate, with a mean time to successful cannulation of 65 days after the initial AP. There were no significant differences in conduit vein diameter before AVF creation between successful maturation and failure groups (3.30 vs 3.26 mm; P = .96). AVF diameter and volume flows on duplex ultrasound after AVF creation were significantly associated with maturation failure (5.63 mm vs 4.71 mm [P = .034]; 834 vs 556 mL/min [P = .048]). No cutoff value could be established using receiver operating characteristic curve analysis. After BAM, mean time to repeated duplex ultrasound was 90 days from initial creation and 33 days from BAM. AVF diameter was not significantly associated with maturation failure on post-BAM duplex ultrasound (5.88 vs 5.02 mm; P = .13). However, AVF volume flow <500 mL/min on duplex ultrasound after BAM was significantly associated with failure of additional APs and unsuccessful maturation (area under the receiver operating characteristic curve, 0.778; P = .01). As shown in Figs 1 and 2, primary patency at 6 and 12 months was 61% and 52%, respectively. Primary assisted patency was 87% and 61%, respectively. Secondary patency was 96% and 70%, respectively, with 1.47 reinterventions per access year. AVFs requiring BAM as an initial AP can successfully achieve maturation in a majority of cases, but volume flows <500 mL/min after percutaneous transluminal angioplasty are associated with high failure rates despite additional APs.Fig 2Number of arteriovenous fistulas (AVFs) at risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)