Primary Balloon Angioplasty Versus Conventional Dilatation During Arteriovenous Fistula Procedure In ESRD Patients With Small Vein Diameter

Objective: The purpose of this research is to determine whether intraoperative primary balloon angioplasty (PBA) is a useful tool for expanding small-caliber veins before an AVF can be built. Patients and methods: This investigation was designed as a single-center randomized-controlled trial. Participating patients had end-stage renal disease (ESRD), a small vein diameter (≤ 2.5 mm), and were advised to undergo AVF creation. One group, the Primary Balloon Angioplasty (PBA) group, underwent the insertion of a 0.018-inch guidewire through the cephalic or basilic veins under fluoroscopic guidance. A noncompliant balloon was then advanced over the guidewire and gently inflated to reach a final diameter of 4 mm. These veins were dilated in the second group (Hydrostatic Dilatation (HD) group) using a high-pressure sterile saline solution. After that, both groups had an end-to-side anastomosis using 6/0 polypropylene running sutures. Results: 40 patients were eligible to participate between January 2023 and September 2024, and they were divided into two groups. There was an instantaneous success rate of 100% in the PBA group and 80% in the HD group. The main patency rate at six months was 95% in the PBA group and 67% in the HD group (P = 0.038). The first puncture time in the PBA group was 29.7±4.86 days (range: 21-39 days), whereas in the HD group it was 49.35±4.32 days (range: 41-56 days) (P <0.001). This difference was statistically significant. A functional AVF was achieved by twenty patients (100%) in the PBA group and nineteen patients (90%) in the HD group (P = 0.5). Conclusion: For AVF treatments, primary balloon angioplasty (PBA) seems to be efficient and more successful than hydrostatic dilatation (HD). It offers greater long-term patency, lower complication rates, higher immediate success rates, and less time for use. It requires supplementary therapy and has a longer process time.