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Treatment of restenosis in radiocephalic arteriovenous hemodialysis fistulas: percutaneous transluminal angioplasty or drug-coated balloon

Tina R Haave, Frode Manstad-Hulaas, Reidar Brekken
Acta Radiologica 2019 March 21, : 284185119838173

BACKGROUND: Percutaneous transluminal angioplasty (PTA) is an established treatment of arteriovenous fistula (AVF) stenosis. Drug-coated balloons (DCB) are coated with an antiproliferative drug intended to decrease neointimal hyperplasia and restenosis.

PURPOSE: To investigate the patency after treatment of restenosis in radiocephalic AVFs with PTA versus DCB.

MATERIAL AND METHODS: A retrospective study comprising 26 patients, recruited from treatment registers, receiving at least one previous PTA and a re-intervention (13 PTAs and 13 DCBs) at the same anatomic location, were observed for 24 months. Patency after re-intervention was compared between the two cohorts. Furthermore, an intra-subject analysis, comparing patency before and after DCB, was performed in the DCB cohort. The Kaplan-Meier method was used to estimate the proportion of stenosis-free patients at different time points after treatment.

RESULTS: After 12 and 24 months, the estimated proportions of stenosis-free patients were 61% and 31%, respectively, in the DCB cohort, compared to 40% and 15% in the PTA cohort. In the intra-subject analysis, 15% and 8% of the patients treated with PTA remained stenosis-free after 12 and 24 months, respectively. Patients treated with DCB had significantly longer patency than patients in the PTA cohort (median 16 vs. 5 months, respectively; P = 0.05). Additionally, in the intra-subject analysis, patency after DCB treatment exceeded PTA (median 16 vs. 5 months, respectively; P = 0.01).

CONCLUSION: Our results indicate that DCB angioplasty is associated with significantly improved patency in the treatment of restenosis in radiocephalic AVFs. A longer follow-up or randomized controlled trial is warranted.


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