TITLE: Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study.
BACKGROUND: Current guidelines recommend referral of patient with renal failure for access creation 6 months before planned dialysis. There is a growing cohort of patients that require long-term hemodialysis without adequate preparation. Temporary dialysis catheters and rapid access arteriovenous grafts (AVG) are far from being an ideal solution in this scenario. In an effort to expedite maturation of autogenous arteriovenous fistulae (AVF), balloon-assisted maturation (BAM) was advised by some authors. This technique still lacks the support of high-level evidence studies. We investigated the ability of intra-operative BAM to induce early functional maturation of AVFs.
METHODS: This is a prospective randomized controlled study conducted in a tertiary referral center, with a catchment area of more than 15 million population. Cases were divided into two groups; Group (A), where BAM technique was performed, while in the control group (B), the standard technique was used (NO BAM) for creation of AVFs.
RESULTS: Between June 2017 and May 2019, 300 cases were recruited from a total of 648 primary AVF creation instances. Patients' age ranged from 19 to 89 (mean 51.17 ±SD 15.5) years. Group A (BAM) included 52.3% (n = 157) AVFs, while Group B included 47.7% (n = 143) AVFs. The average maturation time was 3.7 weeks (SD ± 1.3, 95% CI 3.55-3.95) and 5.91 weeks (SD ± 2.2, 95% CI 5.55-6.26) for both groups, respectively (p = 0.0001). 78.3% of the AVFs that underwent BAM showed early maturation within 2-4 weeks vs 32.2% only in the NO BAM group (p = 0.002). Successful functional maturation was higher among cases of the BAM group (93%), compared to the NO BAM group (77%) (p = 0.001). Complication rates were 9.6% and 4.9% in the two groups, respectively (p = 0.042).
CONCLUSION: BAM can play a pivotal role in helping the dialysis society meet the goals of the Fistula First Initiative, keeping in mind that this comes with an increased risk of complications. BAM should be considered only when unplanned early access to long-term dialysis is required.
SOURCE: Elkassaby M, Elsaadany N, Mowaphy K, et al. Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study[J]. Vascular, 2020:1708538120979872. DOI: 10.1177/1708538120979872.
背景：目前的指南建议将肾衰竭患者转诊至计划的透析前6个月。越来越多的患者需要长期的血液透析而没有足够的准备。在这种情况下，临时透析导管和快速进入动静脉移植物（AVG）远非理想的解决方案。为了加快自体动静脉瘘（AVF）的成熟，一些作者建议进行球囊辅助成熟（BAM）。该技术仍缺乏高级证据研究的支持。我们调查了术中BAM诱导AVFs早期功能成熟的能力。
方法：这是在三级转诊中心进行的前瞻性随机对照研究，该地区的覆盖区域人口超过1500万。病例分为两组。A组，执行BAM技术，而对照组（B组），使用标准技术（NO BAM）建立AVF。
结果：2017年6月至2019年5月，从648个初次建立AVF中招募了300个案例。患者的年龄为19至89岁（平均51.17 ±SD 15.5）。 A组（BAM）包括52.3％（n = 157）AVF，而B组包括47.7％（n = 143）AVF。两组的平均成熟时间分别为3.7周（SD±1.3，95％CI 3.55-3.95）和5.91周（SD2.2，95％CI 5.55-6.26）（p = 0.0001）。接受BAM的AVF中有78.3％在2-4周内显示出早熟，而仅NO BAM组中只有32.2％（p = 0.002）。与NO BAM组（77％）相比，BAM组中成功的功能成熟度更高（93％）（p = 0.001）。两组的并发症发生率分别为9.6％和4.9％（p = 0.042）。
结论：BAM在帮助透析现状实现“瘘管优先行动”的目标方面可以发挥关键作用，请记住，这会增加并发症的风险。仅在需要计划外的长期透析长期使用时，才应考虑BAM。
启发：球囊扩张促成熟可推进内瘘的成熟速度，对于紧急需启动透析的患者有一定的好处，但同时需要注意其并发症，注意沟通。
