Prognostic factors of target lesion patency after drug-coated balloon angioplasty in hemodialysis arteriovenous fistulas

Abstract

Background:

Arteriovenous fistulas (AVFs) are essential for long-term hemodialysis access, but recurrent stenosis remains a major clinical challenge. Drug-coated balloon (DCB) angioplasty demonstrates improved patency outcomes. However, factors influencing its durability are not fully understood.

Purpose:

This study aimed to evaluate clinical outcomes of DCB angioplasty for dysfunctional AVFs and to identify independent clinical and procedural predictors.

Methods:

In this retrospective, single-center cohort study, 195 hemodialysis patients underwent their first DCB angioplasty for significant AVF stenosis between April 2021 and February 2024. Patient demographics, lesion characteristics, and procedural details were analyzed. TLPP (freedom from clinically driven target lesion revascularization or access circuit thrombosis) was assessed using Kaplan–Meier analysis, and predictors of patency loss were evaluated with Cox proportional hazards modeling. Variables with strong collinearity were excluded from the multivariable Cox model; notably, post-DCB vessel diameter was omitted from the multivariable model due to correlation with balloon size.

Results:

TLPP at 6, 12, and 24 months was 68.5%, 33.7%, and 14.9%, respectively. In multivariable analysis, non-juxta-anastomotic lesions (HR 2.98, p < 0.001), antiplatelet therapy (HR 1.37, p = 0.048) were independently associated with an increased risk of TLPP loss. Conversely, a longer interval from prior PTA (HR 0.64, p < 0.001), and larger balloon size (HR 0.63, p = 0.003), were associated with reduced risk. Kaplan–Meier curves demonstrated superior outcomes for juxta-anastomotic lesions, patients without antiplatelet therapy, and those with longer prior PTA intervals, larger balloons, and larger post-DCB diameters.

Conclusions:

Juxta-anastomotic location, absence of antiplatelet therapy, longer prior PTA intervals, and larger DCB size are associated with improved TLPP. Kaplan–Meier analysis also indicated that larger post-DCB diameter was associated with improved TLPP.