Preliminary analysis of the effect of balloon-assisted autologous arteriovenous fistula maturation and its effect on patency / 中华肾脏病杂志

ABSTRACT

Objective:To analyze the efficacy of balloon-assisted autologous arteriovenous fistula (AVF) maturation and its effect on patency.Methods:It was a single-center prospective cohort study. The patients who underwent balloon-assisted maturation (BAM) due to poor AVF maturation in Haidian Hospital, the Third Hospital of Peking University from November 2020 to May 2021 were enrolled. The clinical data and relevant data before and after BAM were collected, and then the immediate success rate and primary patency rate at 6 and 12 months after BAM were analyzed. Cox regression analysis method was used to identify the risk factors of restenosis of AVF patency after BAM.Results:A total of 96 patients treated with BAM due to poor AVF maturation were enrolled, with age of (56.98±13.20) years old, 54 males (56.25%) and 42 females (43.75%). The technical success rate of BAM was 100% (96/96), the clinical success rate of BAM was 96.88% (93/96), and there was no related serious complication. The primary patency rates were 83.33% (80/96) and 59.38% (57/96) at 6 and 12 months, respectively. The internal diameter of anastomotic vein ( t=-19.257 , P<0.001), internal diameter of anastomotic artery ( t=-9.131 , P<0.001), internal diameter of brachial artery ( t=-5.445 , P<0.001) and brachial artery blood flow ( t=-22.739 , P<0.001) after BAM were higher than those before BAM. Univariate Cox regression analysis results showed that stenosis number, stenosis length ≤2 cm, high-pressure balloons, local anaesthetic were all correlated with restenosis of AVF after BAM (all P<0.05) . Multivariate Cox regression analysis results showed that stenosis length ≤2 cm was an independent related factor of restenosis of AVF after BAM at 6 months ( HR=0.022, 95% CI 0.006 -0.075, P<0.001) and at 12 months ( HR=0.027, 95% CI 0.009 -0.082, P<0.001). Conclusions:BAM is safe and effective for AVF maturation, and has a high success rate and reliable patency. Preoperative stenosis length >2 cm is an independent risk factor of AVF restenosis after BAM.