Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas
PURPOSE: To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure. METHODS: This study included patients who underwent AVF surgery using an autogeno...
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| Format: | Article |
| Language: | English |
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Galenos Publishing House
2025-01-01
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| Series: | Diagnostic and Interventional Radiology |
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| Online Access: | https://www.dirjournal.org/articles/staged-angioplasty-using-a-full-length-balloon-catheter-to-achieve-maturation-of-arteriovenous-fistulas/doi/dir.2024.232607 |
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| _version_ | 1841556575064424448 |
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| author | Chung Won Lee Chang Ho Jeon Sung Woon Chung Chung Won Lee Up Huh Jongwon Kim Hyuncheol Jeong |
| author_facet | Chung Won Lee Chang Ho Jeon Sung Woon Chung Chung Won Lee Up Huh Jongwon Kim Hyuncheol Jeong |
| author_sort | Chung Won Lee |
| collection | DOAJ |
| description | PURPOSE: To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure.
METHODS: This study included patients who underwent AVF surgery using an autogenous vein between February 2020 and June 2021 and received staged angioplasty with a full-length balloon catheter. To minimize balloon overlap and the risk of barotrauma to the immature vein, serial-staged upsizing balloon angioplasty with a long balloon catheter covering the entire vein segment was employed approximately 2 weeks apart.
RESULTS: Twenty-three patients (mean age, 69.50 years; mean follow-up, 620.62 days) with average diameters of the radial artery and cephalic vein at 2.14 ± 0.5 mm and 2.43 ± 0.5 mm, respectively, were enrolled. In the first procedure, the average AVF diameter and flow were 4.03 ± 0.57 mm and 438.08 ± 220.95 mL/min, respectively, with juxta-anastomotic stenosis (JAS) present in 61.5% of cases. After staged full-length BAM, the average fistula diameter and flow improved to 5.95 ± 0.86 mm and 717.52 ± 305.95 mL/min, respectively. Maturation was achieved in 87% of the cases. No hematomas or ruptures occurred around the arterialized veins. Despite successful maturation and cannulation, 65.2% of the patients required additional percutaneous transluminal angioplasty (PTA) during the follow-up period. The necessity for PTA was determined by the presence of JAS prior to the first staged full-length BAM, with an odds ratio of 11.74 (95% confidence interval: 1.31–104.96, P = 0.03).
CONCLUSION: Staged full-length BAM can be safely used in patients with small veins requiring further maturation. Most patients achieved successful cannulation following maturation without post-procedural complications.
CLINICAL SIGNIFICANCE: Staged full-length BAM is a safe and effective method for enhancing maturation in patients with underdeveloped small veins. |
| format | Article |
| id | doaj-art-71c84a4bb0c94f69a158508d981f06e6 |
| institution | Kabale University |
| issn | 1305-3825 1305-3612 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Galenos Publishing House |
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| series | Diagnostic and Interventional Radiology |
| spelling | doaj-art-71c84a4bb0c94f69a158508d981f06e62025-01-07T07:21:29ZengGalenos Publishing HouseDiagnostic and Interventional Radiology1305-38251305-36122025-01-01311455110.4274/dir.2024.232607Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulasChung Won Lee0https://orcid.org/0000-0002-1160-6003Chang Ho Jeon1https://orcid.org/0000-0002-1762-5379Sung Woon Chung2https://orcid.org/0000-0002-7978-8595Chung Won Lee3https://orcid.org/0000-0002-1160-6003Up Huh4https://orcid.org/0000-0002-7739-3979Jongwon Kim5https://orcid.org/0000-0001-5782-4834Hyuncheol Jeong6https://orcid.org/0000-0003-2556-0808Pusan National University School of Medicine, Department of Thoracic and Cardiovascular Surgery, Yangsan, Republic of KoreaThe Catholic University of Korea, College of Medicine, Eunpyeong St. Mary’s Hospital, Department of Radiology, Seoul, Republic of KoreaPusan National University School of Medicine, Department of Thoracic and Cardiovascular Surgery, Yangsan, Republic of KoreaPusan National University School of Medicine, Department of Thoracic and Cardiovascular Surgery, Yangsan, Republic of KoreaPusan National University School of Medicine, Department of Thoracic and Cardiovascular Surgery, Yangsan, Republic of KoreaPusan National University Hospital, Biomedical Research Institute, Department of Thoracic and Cardiovascular Surgery, Busan, Republic of KoreaPusan National University Hospital, Biomedical Research Institute, Department of Thoracic and Cardiovascular Surgery, Busan, Republic of KoreaPURPOSE: To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure. METHODS: This study included patients who underwent AVF surgery using an autogenous vein between February 2020 and June 2021 and received staged angioplasty with a full-length balloon catheter. To minimize balloon overlap and the risk of barotrauma to the immature vein, serial-staged upsizing balloon angioplasty with a long balloon catheter covering the entire vein segment was employed approximately 2 weeks apart. RESULTS: Twenty-three patients (mean age, 69.50 years; mean follow-up, 620.62 days) with average diameters of the radial artery and cephalic vein at 2.14 ± 0.5 mm and 2.43 ± 0.5 mm, respectively, were enrolled. In the first procedure, the average AVF diameter and flow were 4.03 ± 0.57 mm and 438.08 ± 220.95 mL/min, respectively, with juxta-anastomotic stenosis (JAS) present in 61.5% of cases. After staged full-length BAM, the average fistula diameter and flow improved to 5.95 ± 0.86 mm and 717.52 ± 305.95 mL/min, respectively. Maturation was achieved in 87% of the cases. No hematomas or ruptures occurred around the arterialized veins. Despite successful maturation and cannulation, 65.2% of the patients required additional percutaneous transluminal angioplasty (PTA) during the follow-up period. The necessity for PTA was determined by the presence of JAS prior to the first staged full-length BAM, with an odds ratio of 11.74 (95% confidence interval: 1.31–104.96, P = 0.03). CONCLUSION: Staged full-length BAM can be safely used in patients with small veins requiring further maturation. Most patients achieved successful cannulation following maturation without post-procedural complications. CLINICAL SIGNIFICANCE: Staged full-length BAM is a safe and effective method for enhancing maturation in patients with underdeveloped small veins.https://www.dirjournal.org/articles/staged-angioplasty-using-a-full-length-balloon-catheter-to-achieve-maturation-of-arteriovenous-fistulas/doi/dir.2024.232607arteriovenous fistulaballoon-assisted maturationhemodialysismaturationstenosis |
| spellingShingle | Chung Won Lee Chang Ho Jeon Sung Woon Chung Chung Won Lee Up Huh Jongwon Kim Hyuncheol Jeong Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas Diagnostic and Interventional Radiology arteriovenous fistula balloon-assisted maturation hemodialysis maturation stenosis |
| title | Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas |
| title_full | Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas |
| title_fullStr | Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas |
| title_full_unstemmed | Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas |
| title_short | Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas |
| title_sort | staged angioplasty using a full length balloon catheter to achieve maturation of arteriovenous fistulas |
| topic | arteriovenous fistula balloon-assisted maturation hemodialysis maturation stenosis |
| url | https://www.dirjournal.org/articles/staged-angioplasty-using-a-full-length-balloon-catheter-to-achieve-maturation-of-arteriovenous-fistulas/doi/dir.2024.232607 |
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