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.