title: Clinical experience with office-based duplex-guided balloon-assisted maturation of arteriovenous fistulas for hemodialysis.
abstract: BACKGROUND
  To examine the effect of office-based duplex-guided balloon-assisted maturation (DG-BAM) on arteriovenous fistula (AVF), we retrospectively analyzed our experience.
  
  
  METHODS
  Over the past 10 months, we performed 185 DG-BAMs (range, 1-8 procedures; mean, 3.7) in 45 patients (29 male, 16 female; mean age, 68.2 ± 12.8 years) with 31 radial-cephalic, 7 brachial-cephalic, and 7 brachial-basilic AVFs. Balloon sizes (3-10 mm) were chosen based on duplex measurements (1-2 mm larger than minimal vein diameter). Forearm AVFs were dilated to 8 mm, and arm AVFs were dilated to 10 mm.
  
  
  RESULTS
  All cases but one (99.5%) were successfully dilated. This exception was a large AVF rupture that required surgical repair. AVFs failed to mature in seven of the remaining 44 patients (16%) despite DG-BAM because of proximal vein stenoses (PVS). Four patients had cephalic arch stenoses, and three had proximal subclavian vein stenoses. Arm AVFs were more commonly associated with PVS (6 of 14 patients, 43%) as compared with the ones placed in the forearm (1 of 30 patients, 3.3%), with a P value of 0.0024. All these seven AVFs subsequently matured after successful balloon angioplasty of the venous outflow.
  
  
  CONCLUSIONS
  These data suggest that office-based DG-BAM of AVFs is feasible, safe, and averts nephrotoxic contrast and radiation. PVS appear to be the most common cause of failure for AVFs subjected to BAM. Because arm AVFs are at increased risk of PVS, we suggest that a careful duplex evaluation of the outflow be performed in these cases and in all AVFs that fail to mature.
authors: Maimonides Medical Center, Brooklyn, NY, USA. jgallagher03@yahoo.com
authors: James J
authors: JJ
authors: Gallagher
authors: Pamela
authors: P
authors: Boniscavage
authors: Enrico
authors: E
authors: Ascher
authors: Anil
authors: A
authors: Hingorani
authors: Natalie
authors: N
authors: Marks
authors: Alexander
authors: A
authors: Shiferson
authors: Daniel
authors: D
authors: Jung
authors: Robert
authors: R
authors: Jimenez
authors: Daniel
authors: D
authors: Novak
authors: Theresa
authors: T
authors: Jacob
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional / Q000379:methods*; D034941:Upper Extremity / Q000098:blood supply*