Balloon-assisted maturation of arteriovenous fistula with paclitaxel-coated versus plain balloons: A randomized comparative study

Background: The physiological process of AVF maturation involves substantial venous remodeling, characterized by increased diameter, wall thickening, and increased flow. When this process is inadequate, the resulting AVF cannot support the hemodynamic requirements of dialysis. Solving this clinical challenge, several techniques have evolved to improve early patency and promote early maturation. One such technique is balloon assisted maturation (BAM). Methods: Prospective, double-arm randomized comparative cohort study conducted at the Department of Vascular Surgery between March 2022 and March 2025, followed up for 1 year, comparing BAM with drug-coated balloon versus BAM with plain old angioplasty balloon. Results: Primary patency at 12 months was significantly higher in the DCB group (84.1% vs 69.2%, p = 0.04). The DCB group had significantly lower reintervention rates at 12 months (14.3% vs 28.2%, p = 0.04). Conclusions: Balloon-assisted maturation with drug-coated balloons signifies an advance in proactive AVF maturation management.