Guideline recommendations on minimal blood vessel diameters and arteriovenous fistula outcomes

Collateral Vein Ligation for Arteriovenous Fistula Maturation: A Pilot Study

Objectives

Native arteriovenous fistulae (AVF) may fail to achieve adequate blood flow or size for successful cannulation and dialysis. No clear strategy exists concerning the effectiveness of collateral vein ligation (CVL) to improve AVF maturation. The aim of this study was to evaluate the effectiveness of CVL in improving AVF maturation.

Methods

A retrospective study was performed, including all patients who underwent CVL for delayed AVF maturation between January 2023 and December 2023. Combined procedures, such as concomitant venous stenosis angioplasties, were excluded. Evolution of AVF flow after CVL compared with AVF flow before CVL was recorded. The primary endpoint was defined as successful maturation after CVL. The AVF was considered mature when it could be routinely cannulated for the total duration of dialysis, for at least six months.

Results

Median follow up was eleven months (range 6-14 months). CVL allowed successful maturation in five of the six patients, with a median AVF flow increase of 44%. In these five patients, sustained dialysis after CVL was uneventful, without need for any additional interventions.

Conclusion

These results highlight the potential effectiveness of CVL in improving AVF maturation, although larger studies are needed to confirm these findings.

Improved Ultrasound-Guided Balloon-Assisted Maturation Angioplasty Using Drug-Eluting Balloons in the First Autogenous Arteriovenous Fistula Procedure: Early Experience

In patients with end-stage renal failure requiring hemodialysis, autogenous arteriovenous fistula (AVF) is preferred over tunneled dialysis catheters due to lower complications and costs. However, AVF maturation failure remains a common issue due to small vein size, multiple venipunctures, and other factors. Guidelines recommend using vessels of >2 mm for forearm AVFs and >3 mm for upper arm AVFs. This study investigates the use of intraoperative Doppler ultrasound (DUS)-guided Balloon-Assisted Maturation (BAM) with drug-eluting balloons (DEB) during initial AVF creation. Data from 114 AVF procedures, of which 27.2% underwent BAM, were analyzed. BAM was performed in 25 distal radio-cephalic and 6 proximal brachio-cephalic AVFs. With DUS guidance, vein stenosis was identified and treated using DEB. Technical success was achieved in all cases, with no early mortality. Early BAM-related complications were minimal, and no AVF thrombosis occurred. AVF maturation time was 15 days (SD: 3), and no further complications were reported during a mean follow-up of 10.38 months. Using BAM with DEB during AVF creation led to successful maturation and dialysis use without the need for secondary procedures. This study emphasizes the importance of identifying AVF failure risk early and utilizing DUS-guided procedures to enhance AVF outcomes. A more liberal use of intraoperative BAM could limit reinterventions in patients undergoing AVFs.