Abstract:  Objective  To evaluate the efficacy of balloon dilation, catheter dilation, and hydraulic dilation techniques for small-caliber veins in arteriovenous fistula (AVF) surgery of diabetic nephropathy patients.  Methods  This retrospective study enrolled 97 diabetic nephropathy patients for the  construction of a new AVF at Shaoyang Central Hospital and its East Branch from January 2020 to January 2023. The preoperative cephalic vein diameters (tourniquet applied) were less than 2.5 mm in all patients. Based on intraoperative vein dilation technique, the patients were divided into three groups: balloon dilation group (n=30, using 3～4 mm×80 mm balloon catheter), catheter dilation group (n=35, using 6F urinary catheter), and hydraulic dilation group (n=32, saline hydraulic dilation). AVF patency rate, re-intervention rate, cephalic vein diameter, and brachial artery blood flow immediately after surgery and after surgery for 1, 2 and 12 months were used to assess their outcomes.  Results  Immediate success rates in balloon, catheter, and hydraulic groups were 96.7%, 85.7%, and 84.4%, respectively, without significant difference (χ²=2.799, P=0.133). After 2 months, AVF maturation rate was significantly higher in balloon group (93.3%) than in catheter (68.6%, χ²=6.190, P=0.013) and hydraulic groups (71.9%, χ²=4.885, P=0.027). After 12 months, re-intervention rate was lower in the balloon group (13.3%) than in catheter (40.0%, χ²=5.737, P=0.017) and hydraulic groups (37.5%, χ²=4.723,      P=0.030). Cephalic vein diameter and brachial artery blood flow showed statistically significant differences among groups immediately after surgery and after surgery for one  and two months (Cephalic vein diameter: F=23.994, 21.311 and 17.305 respectively; P＜0.001. Brachial artery blood flow: F=16.425, 14.002 and 12.631 respectively; P＜0.001). Tukey’s post hoc tests revealed that balloon group had significantly greater cephalic vein diameters than catheter (q=6.390, 3.429 and 4.152 respectively; P=0.001, 0.035 and 0.010 respectively) and hydraulic groups (q=6.711, 4.393 and 5.184 respectively; P=0.001, 0.002 and 0.001 respectively), as well as significantly higher brachial artery blood flow than catheter (q=4.180, 2.551 and 2.758 respectively; P=0.001, 0.034 and 0.020 respectively) and hydraulic groups (q=5.533, 3.357 and 3.374 respectively; P=0.001, 0.004 and 0.003 respectively).  Conclusion  Balloon dilation for small-caliber vein dilation during surgery has the advantages of a higher AVF maturation rate and a lower re-intervention rate in diabetic nephropathy hemodialysis patients, which has a prospect of clinical application.

Key words: Diabetic nephropathy, Arteriovenous fistula, Balloon dilatation, Hemodialysis, Small-caliber vein