The Transradial Approach for Balloon Assisted Maturation of AV Fistulas Avinash Garlapati
1 BS ,
Jeffrey Silpe
2 MD ,
Amit Rao
2 MD ,
Firas Mussa MD,
2 MS ,
Gregg Landis
2 MD
Yana Etkin
2 MD
1Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Division of Vascular and Endovascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Results
Background With the tremendous current and expected increase in arteriovenous fistula (AVF) creations for dialysis access, it is prudent to investigate the most effective techniques for balloon assisted maturation (BAM). Most commonly, as described in the literature, access for this procedure is gained via the fistula. The transradial approach has been thoroughly reported as a safe technique in the interventional cardiology literature, this approach has not been well described for BAM. The purpose of this study is to examine whether the transradial approach for balloon assisted maturation of arteriovenous fistulas is an effective and safe technique.
61.1% of the patients were male with an average age of 61.1 ± 12.2 years. 66.5% of the fistulas were radiocephalic, 22.2% brachiocephalic, and 11.3% brachiobasilic. Complications included 3 access site hematomas and one intraprocedural fistula thrombosis. All complications occurred in the fistula access group. There were no clinically significant thrombotic events involving the radial artery.
Transradial Access
Fistula Access
P-value
Average Procedure Time (min) ± SD
41.5 ± 19.7
48.8 ± 27.6
<.05
Average Contrast Used (ml) ± SD
30.7 ± 16.8
31.7 ± 23.8
>.05
Methods
Conclusion
Future Direction
A retrospective review of all patients who underwent BAM by a single vascular surgeon between August 2015 and August 2020 at a tertiary academic medical center was performed. 212 patients were identified for analysis; 169 had radial access for procedure and 43 were performed via venous access. Procedural details and complications were reviewed and compared between the two groups.
Transradial access for balloon assisted maturation can be a safe and effective alternative to accessing the fistula. It is a technically easier and faster procedure that utilizes a single sheath and allows for simpler visualization of the AV anastomosis.
With the publications of further studies that compare the efficacy and safety of the transradial approach and the direct fistula access approach, it is possible for the transradial approach to be used more commonly of the two for BAM.
Resources
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Ong CW, Yong E, Hong Q, et al. Transradial access for arteriovenous fistuloplasty in Singapore. J Vasc Access 2020; doi:10.1177/1129729820946643 Park SE, Cho SB, Baek HJ, et al. Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study. PLoS ONE 2020; 15(8): e0237798. Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutions. Kidney Int 2002; 62: 1109-1124.