Primary balloon angioplasty of small (≤2 mm) cephalic veins improves primary patency of arteriovenous fistulae and decreases reintervention rates

• Published in: Journal of vascular surgery Vol. 57; no. 1; pp. 131 - 136
• Main Authors: Veroux, Pierfrancesco, MD, Giaquinta, Alessia, MD, Tallarita, Tiziano, MD, Sinagra, Nunziata, MD, Virgilio, Carla, MD, Zerbo, Domenico, MD, Gloviczki, Peter, MD, Veroux, Massimiliano, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 2013
• Subjects: Angioplasty, Balloon; Arteriovenous Shunt, Surgical; Chi-Square Distribution; Dilatation; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - prevention & control; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Physical Examination; Predictive Value of Tests; Renal Dialysis; Risk Assessment; Risk Factors; Surgery; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Upper Extremity - blood supply; Vascular Patency; Veins - diagnostic imaging; Veins - physiopathology; Veins - surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.07.047

Purpose The purpose of this study was to evaluate the effect of primary balloon angioplasty (PBA) of cephalic veins with diameter ≤2 mm on patency and maturation time of autogenous radiocephalic arteriovenous fistulae (AVF) for hemodialysis. Methods Forty patients, all candidates for distal AVF, with a cephalic vein ≤2 mm, were randomized to two different surgical procedures: (1) PBA of a long segment of the cephalic vein from the wrist up to the elbow (n = 19); and (2) hydrostatic dilatation (HD) of a short venous segment (5 cm) at the level of the anastomosis (n = 21). PBA was performed using a standard balloon 4 × 150 mm. Primary end points were primary patency and reintervention rates. Secondary end points were maturation time and the rate of working AVF. Follow-up included physical and duplex ultrasound (DUS) examinations at 1,4, and 8 weeks, and every 3 months thereafter. Results Risk factors were homogeneously distributed between the two groups. Mean vein diameter was 1.8 ± 0.2 mm for the PBA group and 1.7 ± 0.2 mm for HD. Immediate success rate was 100% for PBA and 67% for HD groups ( P = .04). Causes of failure in the HD group included early vein thrombosis in seven patients (33%). Mean fistula maturation time was 32 days in the PBA group and 55 days in the HD group ( P = .04). During the mean follow-up of 7 months, three patients underwent drug-eluting balloon angioplasty for failure of AVF to mature due to stenosis (1 in the PBA group and 2 in the HD group). Six-month reintervention rate was significantly lower in the PBA group (5%) compared with the HD group (43%) ( P = .02). At 6 months, primary patency rates were 95% in the PBA group and 57% in the HD group ( P = .01). Working AVF rate was 100% in the PBA vs 90% in the HD group. Conclusions PBA of very small cephalic veins during the creation of a distal AVF for hemodialysis is a safe and feasible procedure. This technique assures excellent primary patency, maturation time, and dramatically decreases reintervention rate.