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

摘要

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. ? 2013 Society for Vascular Surgery.