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Meta-Analysis
. 2022 Nov:87:351-361.
doi: 10.1016/j.avsg.2022.07.025. Epub 2022 Aug 24.

Primary Balloon Angioplasty Versus Hydrostatic Dilation for Arteriovenous Fistula Creation in Patients with Small-Caliber Cephalic Veins: A Systematic Review and Meta-Analysis

Shahab Aldin Sattari  1 , Ali Reza Sattari  2 , Caitlin W Hicks  3 , Jason F Howard  2 , Sami Shoucair  2 , Anyelin Almanzar  2 , Mohsen Bannazadeh  4 , Margaret W Arnold  2
Affiliations
Meta-Analysis

Primary Balloon Angioplasty Versus Hydrostatic Dilation for Arteriovenous Fistula Creation in Patients with Small-Caliber Cephalic Veins: A Systematic Review and Meta-Analysis

Shahab Aldin Sattari et al. Ann Vasc Surg. 2022 Nov.

Abstract

Background: For arteriovenous fistula (AVF) presence of a venous segment with adequate diameter is essential which is lacking in many patients. To find the optimal augmentation technique in patients with small-caliber cephalic vein (i.e., cephalic vein diameter <3 mm), studies compared primary balloon angioplasty (PBA) versus hydrostatic dilation (HD); however, it remained debatable. This systematic review seeks to determine which technique is preferable.

Methods: We searched MEDLINE, PubMed, Embase, and Google Scholar. Primary outcomes were 6-month primary patency, reintervention, and working AVF. Secondary outcomes were immediate success, the AVF's maturation time (day), and surgical site infection.

Results: Three randomized controlled trials yielding 180 patients were included, of which 89 patients were in the PBA group. The odds ratio (OR) of primary patency was significantly higher in the PBA group (OR 6.09, 95% confidence interval [CI], 2.36-15.76, P = 0.0002), the OR of reintervention was significantly lower in the PBA group (OR 0.16, 95% CI, 0.06-0.42, P = 0.0002), and the OR of working AVF was greater in PBA group (OR 4.22, 95% CI, 1.31-13.59, P = 0.02). The OR of immediate success was significantly greater in the PBA group (OR 11.42, 95% CI, 2.54-51.42, P = 0.002), and the AVF maturation time was significantly shorter in patients who underwent PBA (mean difference -20.32 days, 95% CI, -30.12 to -10.52, P = 0.0001). The certainty of the evidence was high.

Conclusions: PBA of small cephalic veins with diameter ≤2.5 cm is a safe, feasible, and efficacious augmentation method for AVF creation. This technique achieves favorable maturation outcomes, and PBA is superior to the standard hydrostatic dilatation technique.

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Conflict of interest statement

Conflict of interest: None.

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram for the study search and inclusion.
Fig. 2.
Fig. 2.
Cochrane risk-of-bias graph (left) and summary (right).
Fig. 3.
Fig. 3.
Forest plots show odds of primary patency (A), reintervention (B), and working AVF (C) following PBA versus HD.
Fig. 4.
Fig. 4.
Forest plots show immediate success (A) and AVF maturation time (B) following PBA versus HD.
See this image and copyright information in PMC

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