Effectiveness and safety of balloon dilatation in radial artery with autogenous arteriovenous fistula anastomosis for hemodialysis patients: A meta?analysis

Abstract

Background: Achieving successful vascular access for hemodialysis is critical for patients with end?stage renal disease. The creation of an autologous arteriovenous fistula (AVF) is the preferred approach; however, patients with small?caliber radial arteries often face challenges, leading to high rates of AVF failure. Balloon dilation?assisted AVF (BDA?AVF) creation has emerged as a promising technique to address these limitations. This meta?analysis evaluates the effectiveness of BDA?AVF creation in improving primary
patency rates at 6 and 12 months in patients with small?caliber radial arteries.

Materials and Methods: A systematic review and meta?analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta?Analyses guidelines. A total of 25 studies involving 2450 patients were included. The primary outcomes were 6? and 12?month primary patency rates, assessed through a random?effects model. Secondary outcomes included procedural success, maturation rates, and complications. Data extraction and quality assessment were performed independently by two reviewers.

Results: BDA?AVF creation demonstrated a pooled 6?month primary patency rate of 87.8% (95% confidence interval [CI]: 85.8%–89.8%) and a 12?month rate of 75.2% (95% CI:
73.2%–77.2%). Comparatively, traditional AVF techniques achieved significantly lower patency rates (6 months: 61%, 12 months: 50%). Procedural success was reported in 92% of cases, with a maturation rate of 88%. Complications were minor and included
localized hematoma (5%) and mild arterial spasm (3%). BDA?AVF creation is a safe and effective intervention for patients with small?caliber radial arteries, offering superior patency rates compared to traditional methods.

Conclusion: These findings support the adoption of balloon dilation as a standard practice in selected cases, enhancing vascular access outcomes and improving the quality of care for hemodialysis patients. BDA?AVF creation shows promising short? and mid?term outcomes, particularly in patients with small?caliber radial arteries, but evidence for long?term durability is lacking. However, limited long?term follow?up across included studies restricts conclusions about AVF durability, and further high?quality trials are warranted. Future studies should focus on long?term outcomes and cost?effectiveness to further refine this technique.