Clinical Research Acute Complications after Balloon-assisted Maturation Trevor DerDerian, 1 Anil Hingorani, 2 Pamela Boniviscage, 2 Andrea Carollo, 2 and Enrico Ascher, 2 Brooklyn, New York Background: Balloon-assisted maturation (BAM) of arteriovenous fistula (AVF) is a fairly new procedure used to accelerate the process of maturation. As with any procedure, complications do arise. In this retrospective analysis of 336 office-based BAM procedures, 5 major complica- tions were analyzed. These were categorized as formation of wall hematoma, extravasation or rupture, spasm, thrombosis, and formation of puncture-site hematoma. Methods: Prospective data were collected from May 14, 2009 to March 3, 2011 on 336 office- based duplex-guided BAM procedures. Access site puncture, vessel cannulation, wire placement, and balloon advancement and insufflation were duplex guided. Balloon calibers were chosen based on duplex vein measurements and surgeon preference (approximately 1e2 mm larger than minimal vein diameter). Vascular injuries were classified based on postpro- cedural duplex assessment. All patients had follow-up duplex scans within a week after BAM. Results: Of the 336 procedures, the most common injury was formation of wall hematoma (136, 40.5%) followed by extravasation or rupture (32, 9.5%), spasm (26, 7.7%), formation of puncture-site hematoma (13, 3.9%), and thrombosis (5, 1.5%). The injuries were further compared based on balloon size, ranging from small balloon group (3e6 mm) to large balloon group (7e12 mm); entry position, retrograde (n ¼ 177) versus antegrade (n ¼ 159); and type of fistula; radialecephalic (n ¼ 232), brachialecephalic (n ¼ 64), brachialebasilic (n ¼ 34), bra- chialebrachial (n ¼ 4), and ulnarecephalic (n ¼ 2). A significant increase in complications was noted in BAM procedures performed in forearm AVF versus upper arm AVF (67% vs 54%, P ¼ 0.02) and in the large balloon group versus small balloon group (72% vs 52%, P < 0.001). Conclusions: The data suggest that office-based BAM procedures are safe. Fortunately, major complications are not seen at an alarming rate. While increased complications are seen in BAM procedures performed in the forearm and with larger balloons, except for wall hematoma formation (40.19%), each complication occurs in <10% of the procedures. Further studies to help clarify the nature of these complications and their relationship to fistula matu- ration are warranted. INTRODUCTION In the United States, there are currently >600,000 patients with end-stage renal disease, with more than 380,000 of those patients undergoing hemodi- alysis (HD) treatment via vascular access. 1 The cur- rent recommendations from the National Kidney Foundation - Kidney Disease Outcomes Quality Initiative (NKF-DOQI) favor the use of arteriove- nous fistulas (AVFs) over grafts and central catheters, in an effort to decrease cost, increase long-term patency, reduce interventions, and decrease patient morbidity. 2e4 AVF has become the standard of care for dialysis access since the Fistula Presented at the 23rd Winter Annual Meeting of the Peripheral Vascular Surgery Society, January 31-February 3, 2013 - Park City, Utah. 1 Division of Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219. 2 Division of Vascular Surgery, Lutheran Medical Center, 150 55th Street, Brooklyn NY 11220. Correspondence to: Trevor DerDerian, MD, Division of Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA; E-mail: Dr.TrevorDerDerian@gmail.com Ann Vasc Surg 2014; -: 1–5 http://dx.doi.org/10.1016/j.avsg.2013.12.030 Ó 2014 Elsevier Inc. All rights reserved. Manuscript received: June 18, 2013; manuscript accepted: December 28, 2013; published online: ---. 1