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

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.MethodsForty 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.ResultsRisk 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.ConclusionsPBA 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.