Early balloon-assisted-maturation does not reduce patency of mature arteriovenous fistulae

While balloon-assisted maturation (BAM) is increasingly used to promote arteriovenous fistulae (AVF) maturation, its effects on post-maturation patency remain unclear. This study investigates the patency of BAM-matured AVF at 1 year in hemodialysis patients. This retrospective cohort study collected data from patients with AVF created between January 1^st, 2017, and December 31^st, 2021, with subsequent maturation and follow-up at a medical center in Taiwan. Patients were classified as BAM or non-BAM. The group receiving BAM was further stratified into early and late BAM by the median time of balloon catheter cannulation (55 days from AVF creation). Outcomes included primary intervention for mature AVF, including percutaneous transluminal angioplasty and thrombectomy, and patency at 1 year after maturation. Of the 129 eligible patients, 74 (57.36%) received BAM and 55 (42.64%) did not, with comparable baseline characteristics observed between the early- and late-BAM groups. Kaplan-Meier analysis shows comparably sustained post-maturation patency between the BAM and non-BAM (p = 0.238) and early- and late-BAM groups (p = 0.116). The risk of primary intervention was similar between the BAM and non-BAM groups (adjusted hazard ratio (aHR), 1.25; 95% confidence interval (CI), 0.78-2.01, p = 0.346) and the early-BAM and late-BAM groups (aHR, 0.64; 95% CI, 0.32-1.26, p = 0.194) at 1 year by regression analysis. The patency of mature AVF was comparable between patients with and without BAM. Early BAM did not significantly increase the risk of primary intervention at 1 year and may be considered for slow-to-mature AVF.