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Transradial Approach For Balloon-assisted Maturation Of Arteriovenous Fistulas
Jeffrey E. Silpe, MD, MS-HPEd, Avinash Garlapati, BS, Amit Rao, Firas Mussa, MD, Gregg S. Landis, MD, Yana Etkin, MD.
Northwell Health, Lake Success, NY, USA.

OBJECTIVES: 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.
METHODS: 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. For transradial approach, a 6F radial sheath was inserted under ultrasound guidance into the radial artery distal to the anastomosis. In order to perform fistulogram via venous access, the fistula was accessed antegrade with a 6F radial sheath just above the anastomosis and another sheath was placed in the distal aspect of the fistula retrograde. Procedural details and complications were reviewed and compared between the two groups.
RESULTS: In the cohort, 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.The average time for procedures done via radial artery access was significantly shorter as compared to procedures done via fistula access (41.519.7min, vs. 48.827.6min,,p=.05). 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.
CONCLUSIONS: 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 which utilizes a single sheath and allows for simpler visualization of the arteriovenous anastomosis.


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