Long-term efficacy and risk factors of balloon-assisted maturation for radial-cephalic arteriovenous fistula with small-caliber veins

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2023-05-03 DOI:10.1111/hdi.13091

Tsung-Chi Kao, Hung-Chang Hsieh, Sheng-Yueh Yu, Ta-Wei Su, Po-Jen Ko

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引用次数: 0

Abstract

Introduction

Balloon angioplasty maturation (BAM) is a salvage method for autologous arteriovenous fistula (AVF) maturation failure. AVF creation using small-diameter veins is considered to have poor outcomes. Therefore, this study aimed to explore the long-term patency of small-diameter veins (≤3 mm) using BAM.

Methods

BAM was performed if the fistula failed to mature and function adequately to provide prescribed dialysis.

Findings

Out of 61 AVFs, 22 AVFs successfully matured without further intervention (AVF group) and 39 AVFs failed to mature. Except for 1 patient who required peritoneal dialysis, the remaining 38 patients received salvage BAM, and 36 of those successful matured (BAM group). Kaplan–Meier analysis revealed no significant differences between the AVF and BAM groups in terms of primary functional patency (p = 0.503) and assisted functional patency (p = 0.499). Compared with the AVF group, the BAM group had similar assisted primary functional patency (1-year: 94.7% vs. 93.1%; 3-year: 88.0% vs. 93.1%; 5-year: 79.2% vs. 88.3%). In addition, there were no significant difference between groups in the duration of primary functional patency and assisted primary functional patency (p > 0.05). Multivariate analyses showed that vein diameter and number of BAM procedures were independent predictors of primary functional patency in the AVF group and BAM group, respectively. Patient with 1 mm increase in vein size had 0.13-fold probability of having decreased duration of patency (HR = 0.13, 95% CI: 0.02–0.99, p = 0.049), while patients who received two times of BAM procedures were 2.885 as likely to have decreased duration of primary functional patency (HR = 2.885, 95% CI: 1.09–7.63, p = 0.033) than patients who received one BAM procedure.

Discussion

BAM is a relatively effective salvage management option with an acceptable long-term patency rate, even for small cephalic veins.

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球囊辅助成熟治疗小口径静脉桡骨-头侧动静脉瘘的远期疗效及危险因素分析

球囊血管成形术(BAM)是治疗自体动静脉瘘(AVF)成熟失败的一种抢救方法。使用小直径静脉产生AVF被认为效果不佳。因此，本研究旨在利用BAM探讨小直径静脉(≤3mm)的长期通畅程度。方法对瘘道发育不成熟，功能不完善，不能提供规定的透析的患者行BAM。结果61例AVF中22例(AVF组)成功成熟，39例(AVF组)未成熟。除1例患者需要腹膜透析外，其余38例患者接受补救性BAM治疗，其中36例成功成熟(BAM组)。Kaplan-Meier分析显示，AVF组和BAM组在原发性功能通畅(p = 0.503)和辅助功能通畅(p = 0.499)方面无显著差异。与AVF组相比，BAM组具有相似的辅助初级功能通畅(1年:94.7% vs. 93.1%;3年:88.0% vs. 93.1%;5年:79.2% vs. 88.3%)。此外，两组间原发性功能通畅和辅助原发性功能通畅持续时间差异无统计学意义(p > 0.05)。多因素分析显示，静脉直径和BAM手术次数分别是AVF组和BAM组原发性功能通畅的独立预测因素。静脉增大1毫米的患者通畅时间缩短的概率为0.13倍(HR = 0.13, 95% CI: 0.02-0.99, p = 0.049)，而接受两次BAM手术的患者与接受一次BAM手术的患者相比，原发性功能性通畅时间缩短的概率为2.885倍(HR = 2.885, 95% CI: 1.09-7.63, p = 0.033)。BAM是一种相对有效的抢救管理选择，具有可接受的长期通畅率，即使对于小的头静脉也是如此。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.