Dialysis access venous stenosis: treatment with balloon angioplasty 30-second vs. 1-minute inflation times

Percutaneous balloon angioplasty is the standard of care in the endovascular treatment of dialysis access venous stenosis. The significance of balloon inflation times in the treatment of these stenoses is not well defined. Our objective was to examine the outcomes of 30-second vs. 1-minute balloon inflation times on primary-assisted patency of arteriovenous fistulae and grafts. Using a prospectively collected vascular access database, we identified a total of 75 patients referred for access dysfunction during a 5-year period. These patients received 223 interventions (178 with 30-second inflations and 45 with 1-minute inflations). We compared primary-assisted patency during the subsequent 9 months across groups defined by inflation times. Demographics and baseline characteristics were similar across groups. Immediate technical success and patency in the first 3 months were similar across groups (hazard ratio [HR] = 0.86; 95% confidence interval [CI]: 0.34-2.20). After 3 months, however, a 1-minute inflation time was associated with greater incidence of access failure (adjusted HR [aHR] = 1.74; 95% CI: 1.09-2.79). Other predictors of access failure included age over 60 (aHR = 1.02; 95% CI: 1.01-1.04), central location of the lesion (aHR = 2.49; CI: 1.27-4.89), and three or more prior procedures (aHR 2.48; CI: 1.19-5.16). Our data suggest that shorter balloon inflation times may be associated with improved longer term access patency, although the benefit was not observed until after 3 months. Given the increasing demands of maintaining access patency in the era of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative and Fistula First, the role of angioplasty times requires further study.