Purpose: To compare the effectiveness and safety outcomes of drug-coated balloon angioplasty (DCBA) vs conventional balloon angioplasty (BA) for arteriovenous fistula (AVF) stenosis. Materials and Methods: A systematic review was conducted of PubMed and Embase databases from 1966 to May 2019 to identify English-language articles evaluating DCBA vs BA for the treatment of AVF stenosis. Data extracted from each study were synthesized to evaluate target lesion revascularization (TLR), technical success, and mortality for the 2 approaches. Meta-analyses were performed on these outcomes using random effects models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Twelve studies [6 randomized controlled trials (RCTs) and 6 cohort studies] comprising 979 patients were included in this meta-analysis. The pooled results showed that AVFs treated with DCBA had significantly fewer TLRs at 6 months (OR 0.31, 95% CI 0.14 to 0.69, p=0.004) and 12 months (OR 0.45, 95% CI 0.21 to 0.97, p=0.04) than BA. The 2 approaches had similar technical success rates (OR 0.22, 95% CI 0.03 to 1.43, p=0.11). Additionally, the pooled OR of 12-month mortality was 0.71 (95% CI 0.20 to 2.51, p=0.60), indicating no significant difference between DCBA and BA. Subgroup analysis based on study design showed the superiority of DCBA to BA in cohort studies but not RCTs, which had high heterogeneity. Significant publication bias was found in the cohort studies. Conclusion: In de novo or recurrent AVF stenosis, DCBA appears to be an effective procedure associated with lower 6- and 12-month TLR compared with BA. However, larger and randomized controlled studies are warranted to draw definitive conclusions.
BresciaMJCiminoJEAppelK, et al. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966;275:1089–1092.
2.
Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis. 2006;48(suppl 1):S2–S90.
3.
RavaniPPalmerSCOliverMJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol. 2013;24:465–473.
4.
DrewDALokCECohenJT, et al. Vascular access choice in incident hemodialysis patients: a decision analysis. J Am Soc Nephrol. 2015;26:183–191.
5.
HeyeSMaleuxGVaninbroukxJ, et al. Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas. Eur J Radiol. 2012;81:2298–2303.
6.
RajanDKBunstonSMisraS, et al. Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty-are there clinical predictors of patency?Radiology. 2004;232:508–515.
7.
Roy-ChaudhuryPSukhatmeVPCheungAK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol. 2006;17:1112–1127.
8.
PhangCCTanRYPangSC, et al. Paclitaxel-coated balloon in the treatment of recurrent dysfunctional arteriovenous access, real-world experience and longitudinal follow up. Nephrology (Carlton). 2019;24:1290–1295.
9.
IraniFGTeoTKBTayKH, et al. Hemodialysis arteriovenous fistula and graft stenoses: randomized trial comparing drug-eluting balloon angioplasty with conventional angioplasty. Radiology. 2018;289:238–247.
10.
MassmannAFriesPObst-GleditschK, et al. Paclitaxel-coated balloon angioplasty for symptomatic central vein restenosis in patients with hemodialysis fistulas. J Endovasc Ther. 2015;22:74–79.
11.
RoosenLJKaramermerYVosJA, et al. Paclitaxel-coated balloons do not prevent recurrent stenosis in hemodialysis access fistulae: results of a randomized clinical trial. Ital J Vasc Endovasc Surg. 2017;24:35–40.
12.
KatsanosKSpiliopoulosSKitrouP, et al. Risk of death following application of paclitaxel-coated balloons and stents in the femoropopliteal artery of the leg: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2018;7:e011245.
13.
LaiCCFangHCTsengCJ, et al. Percutaneous angioplasty using a paclitaxel-coated balloon improves target lesion restenosis on inflow lesions of autogenous radiocephalic fistulas: a pilot study. J Vasc Interv Radiol. 2014;25:535–341.
14.
KitrouPMKatsanosKSpiliopoulosS, et al. Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472). Eur J Radiol. 2015;84:418–423.
15.
KitrouPMSpiliopoulosSKatsanosK, et al. Paclitaxel-coated versus plain balloon angioplasty for dysfunctional arteriovenous fistulae: one-year results of a prospective randomized controlled trial. J Vasc Interv Radiol. 2015;26:348–354.
16.
ÇildağMBKöseoğluÖFAkdamH, et al. The primary patency of drug-eluting balloon versus conventional balloon angioplasty in hemodialysis patients with arteriovenous fistula stenoses. Jpn J Radiol. 2016;34:700–704.
17.
LučevJBreznikSDinevskiD, et al. Endovascular treatment of haemodialysis arteriovenous fistula with drug-coated balloon angioplasty: a single-centre study. Cardiovasc Intervent Radiol. 2018;41:882–889.
18.
MaleuxGVander MijnsbruggeWHenroteauxD, et al. Multicenter, randomized trial of conventional balloon angioplasty versus paclitaxel-coated balloon angioplasty for the treatment of dysfunctioning autologous dialysis fistulae. J Vasc Interv Radiol. 2018;29:470–475.
19.
SwinnenJJHitosKKairaitisL, et al. Multicentre, randomised, blinded, control trial of drug-eluting balloon vs sham in recurrent native dialysis fistula stenoses. J Vasc Access. 2019;20:260–269.
20.
TrerotolaSOLawsonJRoy-ChaudhuryP, et al. Drug coated balloon angioplasty in failing AV fistulas: a randomized controlled trial. Clin J Am Soc Nephrol. 2018;13:1215–1224.
21.
HaaveTRManstad-HulaasFBrekkenR. Treatment of restenosis in radiocephalic arteriovenous hemodialysis fistulas: percutaneous transluminal angioplasty or drug-coated balloon. Acta Radiol. 2019;21:284185119838173.
22.
PatanèDFaillaGConiglioG, et al. Treatment of juxta-anastomotic stenoses for failing distal radiocephalic arteriovenous fistulas: drug-coated balloons versus angioplasty. J Vasc Access. 2019;60:1584–1589.
23.
YildizI. The efficacy of paclitaxel drug-eluting balloon angioplasty versus standard balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: an analysis of clinical success, primary patency and risk factors for recurrent dysfunction. Cardiovasc Intervent Radiol. 2019;42:685–692.
24.
BjörkmanPWeseliusEMKokkonenT, et al. Drug-coated versus plain balloon angioplasty in arteriovenous fistulas: a randomized, controlled study with 1-year follow-up (The Drecorest II-Study). Scand J Surg. 2019;108:61–66.
25.
CamposRPDo NascimentoMMChulaDC, et al. Stenosis in hemodialysis arteriovenous fistula: evaluation and treatment. Hemodial Int. 2006;10:152–161.
26.
Roy-ChaudhuryPWangYKrishnamoorthyM. Cellular phenotypes in human stenotic lesions from haemodialysis vascular access. Nephrol Dial Transplant. 2009;24:2786–2791.
27.
KennedySAMafeldSBaerlocherMO, et al. Drug-coated balloon angioplasty in hemodialysis circuits: a systematic review and meta-analysis. J Vasc Interv Radiol. 2019;30:483–494.
28.
QuinnRROliverMJDevoeD, et al. The effect of predialysis fistula attempt on risk of all-cause and access-related death. J Am Soc Nephrol. 2017;28:613–620.
29.
AbreuRRiojaSVallespinJ, et al. Predictors of early failure and secondary patency in native arteriovenous fistulas for hemodialysis. Int Angiol. 2018;37:310–314.
30.
WenMLiZLiJ, et al. Risk factors for primary arteriovenous fistula dysfunction in hemodialysis patients: a retrospective survival analysis in multiple medical centers. Blood Purif. 2019;8:1–7.
31.
YanYYeDYangL, et al. A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Ren Fail. 2018;40:379–383.
32.
DinhKLimmerAMParavastuSCV, et al. Mortality after paclitaxel-coated device use in dialysis access: a systematic review and meta-analysis. J Endovasc Ther. 2019;26:600–612.
