Network meta-analysis of trials comparing first line endovascular treatments for arteriovenous fistula stenosis

Tripsianis, Gregory; Christaina, Eleni; Argyriou, Christos; Georgakarakos, Efstratios; Georgiadis, George S.; Lazarides, Miltos K.

doi:10.1016/j.jvs.2020.12.080

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…13–23 Two meta-analyses were excluded as blending RCTs and observational studies in the results, 21,22 another two were excluded as network meta-analyses reporting also indirect estimates. 23,24 Eight meta-analyses were selected for the umbrella review (Figure 1); these included data from 14 RCTs. Six of these meta-analyses also included and observational studies but reported separate results for RCTs.…”

Section: Resultsmentioning

confidence: 99%

Plain versus paclitaxel-coated balloon angioplasty in arteriovenous fistula and graft stenosis: An umbrella review

et al. 2021

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An umbrella review was performed to synthesize the evidence from systematic reviews/meta-analyses of clinical trials investigating the efficacy and safety of paclitaxel-coated balloons (PCB) vs. conventional balloon angioplasty in arteriovenous fistulas (AVFs) and grafts stenosis. Medline (via PubMed) and SCOPUS databases were searched up to July 15th 2020. All meta-analyses that enrolled randomized controlled trials (RCTs) comparing PCB with plain balloons in AVFs and grafts were included. Re-analysis of original data was performed assessing predictive intervals (PI). Quality of the included meta-analyses was assessed using AMSTAR score. Eight meta-analyses were included and four clinical outcomes [target lesion primary patency (TLPP), circuit primary patency, mortality, complication rate] derived from 14 RCTs, were analyzed. There were no significant differences in the TLPP in meta-analyses providing data purely from autologous AVFs. Significant benefits regarding TLPP and circuit primary patency at 3, 6, and 12-months in favor of PCB were reported in four meta-analyses mixing AVFs and grafts; however when PI were assessed, in all but one meta-analysis these included the null value, indicating no significant benefit. In only one meta-analysis significant difference of TLPP at 12-months in favor of PCB was noticed. (Odds Ratio 0.0009 PI: 0.28-0.85) No mortality difference was noticed in four meta-analyses providing data up to 24 months. In conclusion this overview revealed a modest benefit of using PCB angioplasty compared to plain angioplasty in AVFs and graft stenosis. No increased mortality was noticed in the PCB group.

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Section: Resultsmentioning

confidence: 99%

Plain versus paclitaxel-coated balloon angioplasty in arteriovenous fistula and graft stenosis: An umbrella review

et al. 2021

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“…The use of cutting balloons may produce better patency rates in AVF stenosis as demonstrated in a prior study ( 74 ). However, there is stronger evidence in the benefit of DCB angioplasty compared to cutting balloon angioplasty with respect to AVF patency ( 75 ).…”

Section: Adjunctive Treatmentmentioning

confidence: 99%

Thrombectomy approach for access maintenance in the end stage renal disease population: a narrative review

Wu¹,

Kalva²,

Cui³

2023

Cardiovasc Diagn Ther

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Objective: This article reviews current practices and outcomes in endovascular thrombectomy techniques for the treatment of thrombosed arteriovenous grafts (AVGs) and fistulas (AVFs).Background: Arteriovenous (AV) access allows patients with end-stage renal disease (ESRD) to receive hemodialysis. Thrombosis of AV access can lead to delay in hemodialysis or abandonment of access requiring dialysis catheter placement. Endovascular approach has become the preferred treatment option for thrombosed access over surgery. Interventions include removal of thrombus from the AV circuit and treatment of the underlying anatomical abnormality, such as an anastomotic stenosis. Thrombolysis, or the act of dissolving thrombus, is performed by using infusion catheters or pulse injector devices for the administration of fibrinolytic agents. Thrombectomy, or the mechanical removal of thrombus, is performed by using embolectomy balloon catheters, rotating baskets or wires, rheolytic and aspiration mechanisms.Adjunctive methods such as cutting balloon angioplasty, drug-coated balloon (DCB) angioplasty, and stent placement are also used to treat stenoses in the AV circuit. Complications of these procedures include vessel rupture, arterial embolism, pulmonary embolism (PE), and paradoxical embolism to the brain.Methods: This narrative review article was written based on literature search from electronic databases, including PubMed and Google Scholar. Conclusions:The understanding of thrombectomy techniques and their potential complications is essential in the management of patients with thrombosed AV access.

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“…Given the lack of clarity provided by the available RCTs, numerous systematic reviews and meta-analyses have been performed over the years. However, these have also been unable to provide a clearer sense of the effectiveness of DCB us in AV access, noting conflicting conclusions likely related to differences in the meta-analyses, including their unique inclusion criteria, availability of RCTs and other studies for inclusion based on time of publication, and different analytic methods (14,66,76,(103)(104)(105)(106)(107).…”

Section: Summary Of Studies and Meta-analysesmentioning

confidence: 99%

“…For example, a 2020 meta-analysis by Cao et al including 6 cohort studies and 6 RCTS demonstrated a benefit of DCBs when these were combined and when cohort studies were analyzed separately, but not RCTs were analyzed separately, noting high heterogeneity in the RCTs ( 103 ). In the same year, Tripsianis et al published a meta-analysis of 11 RCTs demonstrating superiority of DCBs compared to POBA, while Liao et al published a meta-analysis including 11 RCTs which demonstrated no benefit of DCBs at 6 or 12 months, noting wide variations in patency outcomes across the included studies ( 66 , 104 ). A 2021 meta-analysis by Fong et al included 12 RCTs and employed numerous types of analyses, with the majority suggesting a benefit associated with DCB use ( 105 ).…”

Section: Summary Of Studies and Meta-analysesmentioning

confidence: 99%

Choosing the right treatment for the right lesion, Part II: a narrative review of drug-coated balloon angioplasty and its evolving role in dialysis access maintenance

DePietro¹,

Trerotola²

2023

Cardiovasc Diagn Ther

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Background and Objective: Drug-coated balloons (DCBs) seek to inhibit restenosis in treated hemodialysis access lesions by delivering an anti-proliferative agent (paclitaxel) into the vessel wall. While DCBs have proven effective in the coronary and peripheral arterial vasculature, the evidence for their use in arteriovenous (AV) access has been less robust. In part two of this review, a comprehensive overview of DCB mechanisms, implementation, and design is provided, followed by an examination of the evidence basis for their use in AV access stenosis.Methods: An electronic search was performed on PubMed and EMBASE to identify relevant randomized controlled trials (RCTs) comparing DCBs and plain balloon angioplasty from January 1, 2010 to June 30, 2022 published in English. As part of this narrative review, a review of DCB mechanisms of action, implementation, and design is provided, followed by a review of available RCTs and other studies.Key Content and Findings: Numerous DCBs have been developed, each with unique properties, although the degree to which these differences impact clinical outcomes is unclear. Target lesion preparation, achieved by pre-dilation, and balloon inflation time have proven important factors in achieving optimal DCB treatment. Numerous RCTs have been performed, but have suffered from significant heterogeneity, and have often reported contrasting clinical results, making it difficult to draw conclusions on how to implement DCBs in daily practice. On the whole, it is likely there is a population of patients who benefit from DCB use, but it is unclear which patients benefit most and what device, technical, and procedural factors lead to optimal outcomes. Importantly, DCBs use appears safe in the end-stage renal disease (ESRD) population.Conclusions: DCB implementation has been tempered by the lack of clear signal regarding the benefits of DCB use. As further evidence is obtained, it is possible that a precision-based approach to DCBs may shed light onto which patients will truly benefit from DCBs. Until that time, the evidence reviewed herein may serve to guide interventionalists in their decision making, knowing that DCBs appear safe when used in AV access and may provide some benefit in certain patients.

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Network meta-analysis of trials comparing first line endovascular treatments for arteriovenous fistula stenosis

Cited by 13 publications

References 34 publications

Plain versus paclitaxel-coated balloon angioplasty in arteriovenous fistula and graft stenosis: An umbrella review

Plain versus paclitaxel-coated balloon angioplasty in arteriovenous fistula and graft stenosis: An umbrella review

Thrombectomy approach for access maintenance in the end stage renal disease population: a narrative review

Choosing the right treatment for the right lesion, Part II: a narrative review of drug-coated balloon angioplasty and its evolving role in dialysis access maintenance

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