Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Analysis of Inflation Times and Balloon Types in Dialysis Access: Implications for Post-intervention Primary Patency Christopher Zammit, OMS-IV 1 , Barrie Clark, OMS-IV 1 , Christina Duechle, OMS-IV 1 , Keagan James, OMS-III 1 , David Redden, PhD 2 , Jalal Hakmei, MD 3 Affiliations: 1 Edward Via College of Osteopathic Medicine, Carolinas Campus, Spartanburg, SC, 2 Edward Via College of Osteopathic Medicine, Auburn Campus, Auburn, AL, 3 Medical University of South Carolina Health – Orangeburg

Introduction

Results

Discussion

End stage renal disease (ESRD) impacts more than 808,000 Americans with an estimated $60,000 spent per patient per year, placing significant financial strain on the healthcare system. Total Medicare expenditure for patients with ESRD in 2021 totaled 52.3 billion dollars (Pockros et al. 2021).Approximately 60% of ESRD patients will participate in hemodialysis through a matured arteriovenous fistula (AVF) or arteriovenous graft (AVG). Both AVFs and AVGs are prone to stenosis, often requiring percutaneous transluminal angioplasty (PTA) to maintain patency ( Am J Kidney Dis. 2019). Arteriovenous Fistula or Graft

References Previous literature shows support for 30-second balloon inflation time being optimal to avoid neointimal hyperplasia, the most common cause of re-stenosis. This was further supported by a study that showed no significant difference in 1-minute and 3 minute inflation times, mirroring our results (Forauer et al. 2008). Clinical judgement was used to assess percent occlusion in our study whereas other studies, for example, the CARP study, relied on angiography for a more concise measurement of occlusion (Saiki et al. 2024). Future studies could include biomarkers and imaging studies to assess lesion status and monitor changes on the cellular level in the graft. Our study shows no statistically significant impact on balloon inflation time on time to re-stenosis. Furthermore, there was no significant difference in the balloon type used, lesion type, or percent occlusion pre-treatment. Considering there was no significant difference in ballon type and outcome, cost-saving measures could be considered, if corroborated by additional studies. A limitation of our study is that it only utilized one provider, at a single facility. Future study design could emphasize larger samples sizes, across multiple facilities. 1. P ockros , Benjamin M, Daniel J Finch, and Daniel E Weiner. “Dialysis and Total Health Care Costs in the United States and Worldwide: The Financial Impact of a Single- Payer Dominant System in the US.” Journal of the American Society of Nephrology 32.9 (2021): 2137 – 2139. 2. “ US renal data system 2019 annual data report: epidemiology of kidney disease in the united states.” American Journal of Kidney Diseases (2019). 3. Forauer , Andrew R, Eric K Hoffer, and Karen Homa. “Dialysis access venous stenoses: treatment with balloon angioplasty--1- versus 3-minute inflation times.” Radiology 249.1 (2008): 375 – 381. 4. Saiki, Tomoki et al. “Comparison between the 0 - and 30-s balloon dilation time in percutaneous transluminal angioplasty for restenosed arteriovenous fistula among hemodialysis patients: a multicenter, prospective, randomized trial (CARP study).” Clinical and experimental nephrology 28.7 (2024): 647 – 655. Conclusions

Figure 1. A) Median Days to repeat procedure based on inflation time: <10 seconds = 210 days, 2-3 minutes= 197 days, 5 minutes= 357 days (p= 0.3684). B) Median days to repeat procedure based on balloon type: Conquest TM = 254 days, Gladiator TM = 210 days (p= 0.1057).

1A

1B

The goal of our research is to analyze balloon inflation time on post-intervention patency and if the type of PTA balloon has an influence on post intervention primary patency.

Stenosis

Percutaneous Transluminal Angioplasty

Figure 2. A) Median days to repeat procedure based on percent occlusion: 60%-70% = 132.0 days, 70%-80% = 374.0 days, 80%-90% = 241.0 days, 90%-100% = 110.0 days (p=0.0540) B) Median days to repeat procedure based on lesion type: inflow = 231.0 days, outflow = 259.0 days, intragraft = 200.0 days (p = 0.5153)

Methods

Study cohort consisted of 122 individuals who underwent PTA procedures at the Dialysis Access Institue in Orangeburg, SC, between January 2022 and May 2022. Subjects were randomly assigned to one of three groups with a total inflation time of either less than 10 seconds for 36.9% of subjects (n = 45), 2-3 minutes for 36.1% of subjects (n = 44), and 5 minutes or more for 27.0% of subjects (n = 33). Regarding the procedures, 38.0% were treated with a Conquest TM balloon (n = 46), and 61% were treated with a Gladiator TM balloon (n = 75).

2B

2A

1A

1B

Data was analyzed using Log-rank Test to examine which factors were associated with median time to repeat procedure. Currently, 80.2% of the cohort has had a repeat procedure and 19.8% of the sample is considered censored and waiting to observe a repeat procedure.

Table 1. A) Lesion status of cohort prior to PTA. B) Percentage of graft occlusion pre-treatment in the cohort.

2025 Research Recognition Day

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