title: Primary balloon angioplasty of small (≤2 mm) cephalic veins improves primary patency of arteriovenous fistulae and decreases reintervention rates.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effect of primary balloon angioplasty (PBA) of cephalic veins with diameter≤2 mm on patency and maturation time of autogenous radiocephalic arteriovenous fistulae (AVF) for hemodialysis.
  
  
  METHODS
  Forty patients, all candidates for distal AVF, with a cephalic vein≤2 mm, were randomized to two different surgical procedures: (1) PBA of a long segment of the cephalic vein from the wrist up to the elbow (n=19); and (2) hydrostatic dilatation (HD) of a short venous segment (5 cm) at the level of the anastomosis (n=21). PBA was performed using a standard balloon 4×150 mm. Primary end points were primary patency and reintervention rates. Secondary end points were maturation time and the rate of working AVF. Follow-up included physical and duplex ultrasound (DUS) examinations at 1,4, and 8 weeks, and every 3 months thereafter.
  
  
  RESULTS
  Risk factors were homogeneously distributed between the two groups. Mean vein diameter was 1.8±0.2 mm for the PBA group and 1.7±0.2 mm for HD. Immediate success rate was 100% for PBA and 67% for HD groups (P=.04). Causes of failure in the HD group included early vein thrombosis in seven patients (33%). Mean fistula maturation time was 32 days in the PBA group and 55 days in the HD group (P=.04). During the mean follow-up of 7 months, three patients underwent drug-eluting balloon angioplasty for failure of AVF to mature due to stenosis (1 in the PBA group and 2 in the HD group). Six-month reintervention rate was significantly lower in the PBA group (5%) compared with the HD group (43%) (P=.02). At 6 months, primary patency rates were 95% in the PBA group and 57% in the HD group (P=.01). Working AVF rate was 100% in the PBA vs 90% in the HD group.
  
  
  CONCLUSIONS
  PBA of very small cephalic veins during the creation of a distal AVF for hemodialysis is a safe and feasible procedure. This technique assures excellent primary patency, maturation time, and dramatically decreases reintervention rate.
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies, University Hospital of Catania, Catania, Italy. veroux@unict.it
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Veroux
authors.forename: Alessia
authors.initials: A
authors.lastname: Giaquinta
authors.forename: Tiziano
authors.initials: T
authors.lastname: Tallarita
authors.forename: Nunziata
authors.initials: N
authors.lastname: Sinagra
authors.forename: Carla
authors.initials: C
authors.lastname: Virgilio
authors.forename: Domenico
authors.initials: D
authors.lastname: Zerbo
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
mesh_terms: D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D016009:Chi-Square Distribution; D004106:Dilatation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery