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

Rizvi, Syed; Usoh, Fred; Hingorani, Anil; Iadgarova, Eleanor; Boniscavage, Pamela; Eisenberg, Justin; Ascher, Enrico; Marks, Natalie

doi:10.1016/j.avsg.2016.08.022

Cited by 18 publications

(9 citation statements)

References 16 publications

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“…Rizvi et al. 16 reported that BAM does not decrease AVF maturation times. On the contrary, by causing significant endothelial and smooth muscle cell injury, it causes smooth muscle cell activation, increased cytokine activation, neo-intimal hyperplasia, medial hypertrophy, and vascular remodeling.…”

Section: Discussionmentioning

confidence: 97%

Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study

et al. 2020

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Background Current guidelines recommend referral of patient with renal failure for access creation 6 months before planned dialysis. There is a growing cohort of patients that require long-term hemodialysis without adequate preparation. Temporary dialysis catheters and rapid access arteriovenous grafts (AVG) are far from being an ideal solution in this scenario. In an effort to expedite maturation of autogenous arteriovenous fistulae (AVF), balloon-assisted maturation (BAM) was advised by some authors. This technique still lacks the support of high-level evidence studies. We investigated the ability of intra-operative BAM to induce early functional maturation of AVFs. Methods This is a prospective randomized controlled study conducted in a tertiary referral center, with a catchment area of more than 15 million population. Cases were divided into two groups; Group (A), where BAM technique was performed, while in the control group (B), the standard technique was used (NO BAM) for creation of AVFs. Results Between June 2017 and May 2019, 300 cases were recruited from a total of 648 primary AVF creation instances. Patients’ age ranged from 19 to 89 (mean 51.17 ±SD 15.5) years. Group A (BAM) included 52.3% ( n = 157) AVFs, while Group B included 47.7% ( n = 143) AVFs. The average maturation time was 3.7 weeks (SD ± 1.3, 95% CI 3.55–3.95) and 5.91 weeks (SD ± 2.2, 95% CI 5.55–6.26) for both groups, respectively ( p = 0.0001). 78.3% of the AVFs that underwent BAM showed early maturation within 2–4 weeks vs 32.2% only in the NO BAM group ( p = 0.002). Successful functional maturation was higher among cases of the BAM group (93%), compared to the NO BAM group (77%) ( p = 0.001). Complication rates were 9.6% and 4.9% in the two groups, respectively ( p = 0.042). Conclusion BAM can play a pivotal role in helping the dialysis society meet the goals of the Fistula First Initiative, keeping in mind that this comes with an increased risk of complications. BAM should be considered only when unplanned early access to long-term dialysis is required.

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Section: Discussionmentioning

confidence: 97%

Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study

et al. 2020

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“…One retrospective study comparing maturation times for AVF with and without using BAM in 194 patients found that there was no significant difference (average of 119 days vs 146 days, P=0.73). However, unlike the current study, they only focused on BAM in the postoperative period and did not address PBA at the time of AVF creation to upgrade small caliber veins [22]. Despite the discrepancies in BAM's utility, our study yielded excellent patency and low AVF failure rates in the 643 patients who all underwent at least one BAM.…”

Section: Discussionmentioning

confidence: 84%

Salvage of Suboptimal or Occluded Arteriovenous Fistulas Using a 4 French System From the Radial Artery for Initial Balloon Angioplasty Maturations

Voto

Panetta

2021

Cureus

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Introduction End-stage renal disease (ESRD) is a condition that has seen a large increase in prevalence in recent decades. Paralleling this increase in prevalence is the increasing number of patients requiring vascular access for hemodialysis. Arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) are considered the procedures of choice for hemodialysis access. However, due to the suboptimal venous anatomy (<2 mm diameter, sclerotic vascular walls) and chronic medical conditions (diabetes mellitus) seen in many ESRD patients, successful AVF creation and maturation is not always possible using standard procedures. In this study, we performed primary balloon angioplasty (PBA) at the time of AVF creation with subsequent balloon angioplasty maturation (BAM) procedures in a group of patients with a large proportion of diabetes and suboptimal venous anatomy. The purpose of this study was to compare the assisted patency and survival rates in patients with suboptimal veins used to create AVFs to patients with standard vein AVFs and AVGs. Methods Over a nine-year period, PBA during AVF creation was performed 682 times. Of these, 551 AVFs were matured in optimally sized veins using standard BAM procedures, and 131 AVFs were matured in suboptimal veins utilizing a modified approach. In the subset of patients with suboptimal venous anatomy, we performed the initial BAM procedure via the radial artery utilizing a 4 French system. Additionally, routine clinical surveillance was scheduled throughout the study period for all patients. Suboptimal veins included small (<2 mm diameter), sclerotic, accessory, or recanalized veins. During the study period, 69 AVGs were created and matured using standard graft-gram procedures. A Kaplan-Meier analysis of survival and assisted patency rates comparing the three groups were calculated utilizing data from a retrospective database and medical records. A hazard ratio and a log-rank test were calculated to assess statistical significance. Results The mean time of follow-up for all three groups (n=703) was 43.2 months. Among patients requiring hemodialysis access in the study, the fistula creation rate was 90.8%. Patients with suitable venous anatomy who underwent AVF creation with PBA and standard BAM procedures experienced higher primary assisted patency rates relative to the suboptimal vein AVF and AVG groups (p<0.0001). No difference was seen between the suboptimal vein AVF and AVG groups. Patient survival and the percentage of diabetics were comparable amongst all three groups. Conclusion Using our approach, we were able to achieve a high AVF creation rate amongst a group of patients with a large proportion of suboptimal veins and diabetes. Despite not performing as well as standard vein AVFs in regards to primary assisted patency, the patients with suboptimal vein AVFs experienced similar patency and survival rates as compared to patients receiving AVGs. This new approach enhances the ability to cre...

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“…Ascher et al 15 , Gallagher et al 16 , Derderian et al 17 , and Rizvi et al 18 reported that balloon angioplasty to assist maturation is usually used for treat stenotic non-matured AVF under angiography or ultrasound guidance. They reported a success rate ranged between 55% to 89%.Derderian et al 19 reported that the most common complications were hematoma (40%), extravasation (9%), the formation of puncture site hematoma (4%), and thrombosis (2%).…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of The Failure of Maturation of Native Arterio-Venous Fistula due to Outflow Stenosis for Hemodialysis

El-Ashry

Ewida

Ibrahim

2020

Al-Azhar International Medical Journal

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Background: Arteriovenous fistula (AVF) is a significant procedure for patient in need of hemodialysis. Failure of maturation due to stenosis is a challenge that needs further intervention. Endovascular treatment allows salvaging these fistulae. Aim of the work: To identify the anatomical causes of maturation failure and to assess immediate and long-term clinical effects of PTA of non-mature native (AVF) caused by outflow stenosis using currently available endovascular techniques. Material and Methods: This study was performed on forty patients complaining of stenosis of primary AVF. The mean age is 60.5. Patients were followed-up every two weeks for the first 2 months, then every month for 6 months post-intervention clinically and radiologically. Collected data includes patient's demographics, cause of renal failure, characters of primary AVF, and variables of endovascular intervention, primary patency, and recurrence of stenosis. Results: AVF type was either brachiocephalic (57.5%), brachiobasilic (32.5%) or radiocephalic (10.0%). Fistulography revealed peripheral venous stenosis in 18 patients (45.0%), central venous stenosis in 14 patients (35.0%), and juxta-anastomotic stenosis in 8 patients (20%). Our technical success was achieved in 87.5% of cases; the patency rate was 91.0% in a month, 86.0% in 3 months, and 80.0% in 6 months. Complications were reported in 10 cases. The recurrence was reported in 7 patients (17.5% of cases). Conclusions: Endovascular salvage of failing A-V fistulas with PTA and Stenting is safe and effective. It is associated with high success rates, low complication rates, and rendering the immediate reuse of the failing shunt.

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

Cited by 18 publications

References 16 publications

Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study

Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study

Salvage of Suboptimal or Occluded Arteriovenous Fistulas Using a 4 French System From the Radial Artery for Initial Balloon Angioplasty Maturations

Endovascular Management of The Failure of Maturation of Native Arterio-Venous Fistula due to Outflow Stenosis for Hemodialysis

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