Ann Surg Treat Res.  2016 May;90(5):272-278. 10.4174/astr.2016.90.5.272.

Balloon-assisted maturation for arteriovenous fistula maturation failure: an early period experience

• Park SC
• Ko SY
• Kim JI
• Moon IS
• Kim SD

• KMID: 2163067
• DOI: http://doi.org/10.4174/astr.2016.90.5.272

Abstract

PURPOSE
Balloon-assisted maturation (BAM) is emerging as a salvage management for arteriovenous fistula maturation failure (AVF MF). However, BAM is a relatively new, yet controversial technique for AVF maturation. Therefore, we evaluated the effectiveness of BAM for AVF MF.
METHODS
Between January 2012 and December 2014, 249 AVFs were created. The total MF rate was 24.8%. But, only 110 AVFs were enrolled, including 74 brachiocephalic (BC) AVFs and 36 radiocephalic (RC) AVFs. The follow-up period was 12 months. Among those, there were 42 MFs (22 BC AVFs and 20 RC AVFs) and 68 maturation successes (MS) (52 BC AVFs and 16 RC AVFs). BAM was involved in MF group. We compared the clinical characteristics, AVF flows, and AVF flow ratios of MF and MS groups. Also, we evaluated the etiology, management, and result of MF.
RESULTS
There was no difference in clinical characteristics between MF and MS groups. In MF group, 39 balloon angioplasties (BAs) for 42 AVF MFs were performed. Number of BA was 1.45 ± 0.57 and duration of BA was 21.30 ± 21.24 weeks. BAM rate was 46.2%. For 1 year after AVF creation, AVF flows of MS group were significantly larger than those of MF group (P < 0.05) but there was no difference in AVF flow ratio between MF and MS groups (P > 0.05).
CONCLUSION
BA for AVF MF is a relatively applicable and effective modality. Although a large volume study is necessary, we suggest BAM is an effective salvage management for AVF MF.

Keyword

Balloon angioplasty; Treatment failure; Renal dialysis; Arteriovenous fistula

MeSH Terms

Angioplasty
Angioplasty, Balloon
Arteriovenous Fistula*
Follow-Up Studies
Renal Dialysis
Treatment Failure

Figure

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  Fig. 1 Arteriovenous fistula created in our hospital over 3 years. AVF, arteriovenous fistula; BC, brachiocephalic; RC, radiocephalic; MS, maturation success; MF, maturation failure; f/u, follow-up.

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  Fig. 2 Balloon angioplasty (BA) for balloon assisted maturation of arteriovenous fistula (AVF) maturation failure. (A) Juxtaanastomotic stenosis (JAS) of AVF. Arrow indicates JAS lesion. (B) BA for JAS lesion. (C) Postballooning fistulography shows improvement of JAS lesion. (D) BA for cephalic vein stenosis (CVS) lesion. Arrow indicates inflated balloon. (E) Postballooning fistulography shows improvement of CVS lesion.

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