Effect of primary balloon angioplasty on draining vein diameter and volume flow in patients with arteriovenous fistula: A cohort study. (September 2022)

• Record Type: Journal Article
• Authors: Suhartono, R.; Suhendro, ; Rahardjo, Harrina Erlianti; Harahap, Alida Roswita; Mochtar, Chaidir Arif; Muradi, Akhmadu; Alwi, Idrus; Lydia, Aida; Kekalih, Aria; Soetikno, Vivian; Rustam, Raflis
• Is Part Of: Annals of medicine and surgery. Volume 81(2022)
• Publication Date: 2022-09
• Subjects: Chronic kidney disease -- Arteriovenous fistula -- Primary balloon angioplasty -- Retrospective cohort study; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104426
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) cause major morbidity and mortality in 10% of the global population with CKD. The most common renal replacement therapy is hemodialysis with arteriovenous fistula (AVF) access. AVF often undergoes maturation failure due to feeding artery and draining vein inadequacy. Mechanical dilatation, such as primary balloon angioplasty (PBA), can overcome AVF maturation failure. The volume flow (VF) and diameter of the draining veins in AVF patients must be known to evaluate the effect of PBA on AVF maturation. This study aims to analyze the impact of PBA on VF and draining vein diameter in ESKD patients undergoing AVF surgery. Methods: A retrospective cohort clinical trial was conducted at our institution. A total of 75 participants had AVF with an arterial diameter >1.5 mm or vein diameter at the AVF creation site of 2–4 mm. The subjects were divided into 2 groups: the intervention group undergoing PBA (n = 36) and the control group, without PBA (n = 39). PBA was performed using a Mustang ballon (3–6 mm, Medtronic). Follow-ups were conducted at 1 week, 2 weeks, and 6 weeks after AVF creation. Results: Based on the data, the diameter and VF of the draining veins were significantly larger in the intervention group than in the control group (p < 0.001). Furthermore, we found significant differences in the mean diameter and VF of the draining veins between the control and intervention groups at all stages of examination, from preoperatively to 6 weeks postoperatively (p < 0.001). The strength of the analysis was more than 80%. Conclusion: PBA can increase the diameter and VF of the draining veins in patients with AVF. Highlights: Mechanical dilatation (i.e., primary balloon angioplasty [PBA]) can prevent arteriovenous fistula (AVF) maturation failure. Volume flow and diameter of draining veins in AVF patients must be known to evaluate the effect of PBA on AVF maturation. PBA 1.5 × larger than nominal vein size can increase the diameter and volume flow of draining veins in the AVF procedure. AVF with PBA 1.5 × larger than nominal vein size had a higher probability of AVF maturation than control.