Balloon-Assisted Maturation Is Strongly Associated with Inferior Functional Patency Rates of Arteriovenous Fistulas

Balloon-assisted maturation (BAM) is used to salvage nonmaturing arteriovenous fistulas (AVFs). This study compared long-term patency between naturally matured AVFs and those matured through the BAM and identified factors associated with patency.

This retrospective cohort study included adult patients who achieved AVF maturation between 2018 and 2020, divided into the unassisted maturation (UM) group (N = 1,008) and the BAM group (N = 499). Functional primary patency (creation to first postmaturation reintervention) and cumulative functional patency (creation to abandonment) were analyzed. Cox regression and age-stratified analyses were performed to identify factors influencing patency.

The UM group had significantly greater 1-, 3-, and 5-year functional primary patency rates (88.0%, 70.4%, and 62.5%, respectively) than the BAM group (63.8%, 37.0%, and 24.2%; all P < 0.001). Cumulative patency rates were also significantly greater in the UM group at 1, 3, and 5 years (98.9% vs. 95.0%, 95.1% vs. 85.6%, and 93.6% vs. 76.9%, respectively; all P < 0.001). Multivariate analysis revealed that BAM independently increased the risk of reintervention (hazard ratio (HR) = 2.738; P < 0.001) and abandonment (HR = 3.517; P < 0.001). Male sex (HR = 0.762; P = 0.019) and underweight (HR = 1.297; P = 0.040) were also influencing factors of reintervention. Age-stratified analysis revealed that among patients ≤55 years, diabetes and coronary heart disease additionally increased reintervention risk, whereas in patients >55 years, upper arm AVF additionally increased abandonment risk.

BAM is strongly associated with inferior long-term functional patency of AVFs.