The Clinical Efficacy of Balloon-Assisted Maturation of Autogenous Arteriovenous Fistulae

Abstract

Delayed maturation of arteriovenous fistulae (AVF) among patients who require hemodialysis (HD) can lead to catheter sepsis with its resultant morbidity and mortality. Some have proposed that sequential balloon-assisted maturation (BAM) may accelerate the maturation times of these accesses. On the other hand, serial balloon angioplasty of normal vein may result in stenosis and delay maturation. Although the safety of BAM has been shown, direct comparison to nonmatured AVF has not been explored. Therefore, we conducted a retrospective analysis of our prospectively maintained vascular access database to compare the duration of period to AVF maturation between patients who received BAM and those who were not referred for BAM at our institution. Prospectively collected data over a 3-year period in 194 patients who underwent AVF creation at our institution were retrospectively analyzed. The duration to maturation of the AVF was determined by comparing the period between the creation of the fistula and the first successful cannulation of the fistula. Only patients on HD were included. Patients who underwent BAM or placement of AVF at an outside institution were excluded. Follow-up consisted reviewing of postoperative AVF duplex for patency, hospital and clinic databases, HD center databases, and telephone interviews. Of the 194 patients who had AVF placement, 172 patients were on HD within 2weeks of AVF placement, whereas 22 patients had AVF placed in anticipation of the need for HD. Of the 172 patients on HD within 2 weeks, 54 patients had BAM performed at our institution and 4 patients had BAM at an outside institution, whereas 114 patients were not referred for BAM. Thirty-three of these 114 patients were age and gender matched to compare to the patients who underwent BAM at our institution. At the time of this analysis, of the 54 patients who had BAM, 30 had functional AVF (19 men, 11 women; mean age, 62years; range, 26-86 [standard deviation, SD±18] years). In the BAM group of functioning AVF, n=30, the total number of procedures was 125 (range, 1-8, average 4). The overall average duration to maturation of the AVF was 119days (SD±84days) and 146days (SD±157 days) P=0.73, for BAM and non-BAM, respectively. These preliminary data suggest the role of BAM did not decrease maturation times of AVF and that BAM warrants further scrutiny before further adoption.