Primary balloon angioplasty plus balloon angioplasty maturation to upgrade small-caliber veins (<3 mm) for arteriovenous fistulas

Abstract

Small or suboptimal veins can undergo PBA and then be matured to create functioning AVFs <or=2 months. Overall, >90% autogenous AVF rates can be achieved using PBA and BAM. BAM can be successfully used to mature AVFs created from small veins and salvage thrombosed AVFs in many cases. The use of these techniques may decrease the number of patients requiring AVGs and indwelling catheters.

Future research directions to improve fistula maturation and reduce access failure

“…The BAM technique uses repeated balloon angioplasty to disrupt the venous wall and sequentially dilate the vein to a larger diameter useable fistula; with this technique, it is possible to use even smaller diameter veins for access [179, 180]. However, the concern with this technique lies in its very nature; angioplasty injures the intima and media to produce NIH [181].…”

Balloon-Assisted Maturation (BAM) of the Arteriovenous Fistula: The Good, the Bad, and the Ugly

“…27 More recently a number of authors have described the use of primary balloon angioplasty at the time of surgery to dilate veins as small as 1–1.5mm prior to creation of an AVF, followed by BAM. 27,28 …”

“…85% of their patients were able to achieve maturation and the one year secondary patency was approximately 80%. 28 In a larger series, Chawla et al 27 have described rapid AVF maturation (estimated maturation period of 53 days) using aggressive angioplasty, which caused significant injury to the venous segment. They have hypothesized that this injury (which includes hemorrhage as a result of controlled venous rupture) could be responsible for the remodeling of the venous segment into a large diameter fibrous tube, which could mature more rapidly and also be more resistant to cannulation injury as compared to AVFs that mature in the conventional fashion.…”

“…25,26 In addition, recent papers have described the use of intra-operative “primary balloon angioplasty” at the time of surgery which could allow for AVFs to be created in patients with small arteries and veins (artery < 2mm and vein <2.5mm). 27,28 …”

Fogarty® catheter dilatation of veins smaller than 2.5 mm after completion of the anastomosis during arteriovenous fistula creation

“…Our study was not the first reporting intraoperative use of balloon dilatation during AVF creation. Garcia et al [21] performed the technique in a similar manner to our, but just before starting the anastomosis. They implemented a subsequent balloon dilatation program consisting of sequential angioplasty for maturation of the veins.…”