Pierfrancesco Veroux1, Tiziano Tallarita1, Alessia Giaquinta1, Peter Gloviczki2, Massimiliano Veroux1
1Policlinico of Catania, Catania, Italy; 2Mayo Clinic, Rochester, MN.
OBJECTIVES: To evaluate the novel technique of Primary Balloon Angioplasty (PBA) of cephalic veins with diameter ≤2mm on patency of radio-cephalic arteriovenous fistulae (AVF) before performing the anastomosis.
METHODS: Forty patients, all candidates for distal radiocephalic fistula, with a cephalic vein ≤2 mm, were randomized to undergo dilatation of the cephalic veins with two different techniques, before performing the anastomosis: A) PBA of a long cephalic vein segment from the wrist up to the elbow (n=19); B) hydrostatic dilatation (HD) of a short venous segment (5cm) at the level of the anastomosis (n=21). PBA was performed using a Pacific Extreme Balloon (3.5/4 x 150 mm, Medtronic), inflated at 12 ATM of pressure for a period of 60 seconds. Primary endpoints were primary and assisted patency rates, re-intervention rate, and maturation time. Follow up included physical and DUS examinations at 1-4-8 weeks and every 3 months thereafter.
RESULTS: Immediate success rate was 100% for PBA and 67% for HD groups (p=0.04). Cause of failure in HD group included early vein thrombosis in 7 (33%) patients; Mean fistula maturation time was 32 days (21-38 days) in PBA group and 55 days (34-60 days) in HD group (p=0.04).
During the mean follow up of 7 months (1 to 15 months), 3 patients (7.5%) underwent successful PTA for failure AVF to mature due to stenosis (1 [5.2%] in PBA and 2 [14.3%] in HD groups; p=0.8). Including both early and mid-term reinterventions, the difference between the groups was statistically significant (1 [5.2%] in PBA vs. 9 [42.8%] in HD groups; p=0.02). At 6 months, primary and assisted patency rates were 94.8% and 100% in PBA Group and 57.2% and 66.7% in HD Group (p=0.01).
CONCLUSIONS: Primary “Preventive” Balloon Angioplasty of very small cephalic veins is a safe and feasible procedure. This new technique assures short fistula maturation time, decreased re-intervention rate and excellent mid-term primary patency.
AUTHOR DISCLOSURES: A. Giaquinta, Nothing to disclose; P. Gloviczki, Nothing to disclose; T. Tallarita, Nothing to disclose; M. Veroux, Nothing to disclose; P. Veroux, Nothing to disclose.
Posted April 2012