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Outcomes of balloon-assisted maturation with large-diameter balloons
Amandeep Juneja1, David E Wang2, Litton Whitaker1
1Nuvance Health, Danbury, CT, USA.
The Journal of Vascular Access
|August 16, 2024
Summary
Using large angioplasty balloons for initial balloon-assisted maturation (BAM) of arteriovenous fistulas (AVF) significantly improves maturation rates and reduces the time to catheter-free hemodialysis (HD). This technique leads to better outcomes for AVF patients requiring dialysis.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Arteriovenous Fistula (AVF) maturation is critical for successful hemodialysis (HD).
- Balloon-assisted maturation (BAM) is employed for inadequate AVF.
- Optimizing initial BAM techniques is essential for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of initial BAM using large-diameter angioplasty balloons (≥7 mm).
- To compare outcomes between patients receiving large-diameter versus smaller-diameter (<7 mm) balloons for initial BAM.
- To assess the impact of balloon size on AVF maturation, complications, and time to catheter-free HD.
Main Methods:
- Retrospective review of patients undergoing BAM between 2018-2021.
- Comparison of outcomes between two groups: initial BAM with ≥7 mm balloons (Group I) and <7 mm balloons (Group II).
- Primary outcome: AVF maturation rate. Secondary outcomes: complications, re-intervention rates, vein diameter, and time to catheter-free HD.
Main Results:
- Group I (≥7 mm balloons) showed a significantly higher AVF maturation rate (97% vs. 88%, p=0.003).
- Larger initial vein diameter (5.9 mm vs. 5.1 mm, p=0.03) and reduced need for re-intervention were observed in Group I.
- Group I patients achieved catheter-free HD faster (29 days vs. 42 days, p=0.002) with higher 60-day incidence (83% vs. 67%, p=0.001).
Conclusions:
- Initial BAM with large-diameter angioplasty balloons is associated with superior AVF maturation rates.
- This approach leads to fewer re-interventions and a shorter time to achieving catheter-free hemodialysis.
- Favorable baseline characteristics often correlate with the successful use of larger balloons in BAM procedures.
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