Primary patency with cutting and conventional balloon angioplasty for different types of hemodialysis access stenosis.

PURPOSE: To compare primary patency rates of cutting balloon percutaneous transluminal angioplasty (PTA) (hereafter, cutting PTA) and conventional balloon PTA (hereafter, conventional PTA) in the treatment of different types of hemodialysis access stenosis.

MATERIALS AND METHODS: The institutional review board approved this study. Written informed consent was obtained for the prospective component of this study and waived for the retrospective component. Patients in whom treatment with cutting PTA alone or conventional PTA alone was clinically successful formed the two study groups. Primary patency for the lesion was defined as uninterrupted patency of the treated site after balloon PTA. A site was no longer considered patent when the patient underwent treatment for hemodialysis access failure due to restenosis of the treated site. Primary patency rates for lesions were calculated with the Kaplan-Meier method according to the type of stenosis. We compared the two groups by using the log-rank test to determine statistical significance.

RESULTS: In the cutting PTA group, 62 patients with 77 stenoses (32 men, 30 women; mean age, 65.5 years +/- 10.1 [standard deviation]) achieved clinical success. In the conventional PTA group, 52 patients with 68 stenoses (23 men, 29 women; mean age, 61.9 years +/- 10.2) achieved clinical success. In patients with autogenous venous stenosis, no significant difference in the primary patency rate was noted between groups (P = .369). In patients with graft-to-vein anastomotic stenosis, the primary patency rate was significantly higher for cutting PTA than for conventional PTA (P = .39). In patients with intragraft stenosis, no significant difference in the primary patency rate was noted between groups (P = .379). In patients with in-stent restenosis, no significant difference in the primary patency rate was noted between groups (P = .923).

CONCLUSION: Primary patency rates are significantly higher for cutting PTA in the treatment of graft-to-vein anastomotic stenosis; however, no significant differences in primary patency rates exist between these PTAs in the treatment of autogenous venous stenosis, intragraft stenosis, or in-stent restenosis.