Document Detail

Primary balloon angioplasty plus balloon angioplasty maturation to upgrade small-caliber veins (<3 mm) for arteriovenous fistulas.
MedLine Citation:
PMID:  20471767     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Small-diameter veins are often a limiting factor for the successful creation of arteriovenous fistulas (AVFs). This study evaluated the use of intraoperative primary balloon angioplasty (PBA) as a technique to upgrade small-diameter veins during AVF creation. Sequential balloon angioplasty maturation (BAM) was evaluated as a technique to salvage failed fistulas, expedite maturation, and improve the patency of AVFs after PBA.
METHODS: Sixty-two PBAs were performed in 55 patients with an intent-to-treat using an all-autologous policy. PBAs of veins were performed just before AVF creation using 2.5- to 4-mm angioplasty balloons (1- to 1.5-mm larger than the nominal vein diameter). PBAs were performed through the spatulated end of the vein for a length of up to 8 cm using hydrophilic guidewires and hand inflations without fluoroscopy. BAM was performed in 53 of the 62 PBAs at 2, 4, and 6 weeks after the PBA. Successful outcome was determined as the functional ability to use the fistula for hemodialysis without surgical revision.
RESULTS: Of the 62 PBAs, 53 (85.4%), comprising 47 of the original AVFs and 6 new site AVFs created at other sites, remained patent and subsequently underwent BAM with a resulting functional AVF. Fifteen of the 47 original AVFs: 14 due to occlusion; one AVF with a steal was ligated. Seven of the 14 fistulas that occluded were salvaged using recanalization techniques during sequential BAMs. Two of the seven fistulas that were not salvaged required AVGs (3%), and five patients underwent redo AVFs using alternative veins. These five cases were also performed using PBAs and BAMs technique. One patient with a functioning fistula underwent intentional ligation for steal syndrome and also underwent an alternative site AVF, PBA, and BAM. At 3 months, 53 AVFs were functional and successfully used for dialysis. Overall, a working AVF was obtained at the initial site in 47 of 55 patients (85.4%), and 53 (96.3%) received working AVFs that were functioning for dialysis access.
CONCLUSIONS: 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.
Lorena P De Marco Garcia; Luis R Davila-Santini; Qin Feng; Julio Calderin; Kambhampaty V Krishnasastry; Thomas F Panetta
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Publication Detail:
Type:  Journal Article     Date:  2010-05-14
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-08-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  139-44     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Department of Vascular Surgery, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA.
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MeSH Terms
Aged, 80 and over
Angioplasty, Balloon*
Arteriovenous Shunt, Surgical / adverse effects,  methods*
Graft Occlusion, Vascular / etiology,  physiopathology,  radiography,  therapy*
Kaplan-Meier Estimate
Middle Aged
Renal Dialysis*
Time Factors
Treatment Outcome
Upper Extremity / blood supply*
Vascular Patency*
Veins / physiopathology,  surgery
Venous Thrombosis / etiology,  physiopathology,  radiography,  therapy*

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