Drug-Coated Balloon Angioplasty in Hemodialysis Circuits: A Systematic Review and Meta-Analysis

Kennedy, Sean A.; Mafeld, Sebastian; Baerlocher, Mark O.; Jaberi, Arash; Rajan, Dheeraj K.

doi:10.1016/j.jvir.2019.01.012

Cited by 65 publications

(68 citation statements)

References 27 publications

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“…Our conclusions are different from the 2 meta-analysis studies recently published [19,20]. Kennedy et al reported a significant improvement of patency in the DCB group, both for patency at 6 months (OR 0.40; CI 0.23-0.70) and 12 months (OR 0.20; CI 0.07-0.62).…”

Section: Comparison To Previous Studiescontrasting

confidence: 99%

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Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials

et al. 2020

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Background Restenosis remains a significant problem in endovascular therapy for hemodialysis vascular access. Drug-coated balloon (DCB) angioplasty decreases restenosis in peripheral and coronary artery diseases. The aim of this systematic review and meta-analysis is to assess the patency outcomes following DCB angioplasty, as compared to conventional balloon (CB) angioplasty for the stenosis of hemodialysis vascular access. Methods A comprehensive search in the MEDLINE, EMBASE, and CENTRAL databases was conducted in order to identify eligible randomized controlled trials evaluating DCB angioplasty for hemodialysis vascular access dysfunction. The primary endpoint was the 6-month target lesion primary patency and the secondary endpoints were 12-month target lesion primary patency and procedure-related complications. Risk ratios (RR) were pooled and relevant subgroups were analyzed separately. Results Eleven randomized controlled trials comprised of 487 patients treated with DCB angioplasty and 489 patients treated with CB angioplasty were included. There were no significant

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Section: Comparison To Previous Studiescontrasting

confidence: 99%

“…First, only randomized control studies were used for the metaanalysis conducted in our study; the other studies included cohort studies and retrospective studies that were inherent to selection bias. For example, Kennedy's study [19] included a…”

Section: Comparison To Previous Studiesmentioning

confidence: 99%

Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials

et al. 2020

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“…Consistent with previous studies of DBA in dysfunctional AVFs ( 20 33 ), the present study showed that DBA can be used safely to manage dysfunctional RCAVFs. Moreover, this study offered the opportunity to explore three-year mortality rates.…”

Section: Discussionsupporting

confidence: 92%

“…It is important to note that there are conflicting results amongst meta-analyses ( 31 32 33 ). One meta-analysis published by Khawaja et al ( 31 ) in 2016, assessing two RCTs and four cohort studies, showed improved TLPP at six months for DBA as opposed to PBA.…”

Section: Discussionmentioning

confidence: 99%

“…However, the included studies were clinically heterogeneous and only involved a small number of participants. A meta-analysis published by Kennedy et al ( 33 ) in 2019, including both AVFs and AVGs, reported that DBA resulted in a significant improvement in lesion patency at 3, 6, 12, and 24 months compared to PBA. However, a meta-analysis by Abdul Salim et al ( 32 ) in 2020 found no significant difference in TLPP between DBA and PBA at 1, 3, 6, 7, 12, and 24 months across six RCTs of AVFs.…”

Section: Discussionmentioning

confidence: 99%

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Paclitaxel-Coated Balloon versus Plain Balloon Angioplasty for Dysfunctional Autogenous Radiocephalic Arteriovenous Fistulas: A Prospective Randomized Controlled Trial

Kim

Byun

et al. 2020

Korean J Radiol

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Objective To report the mid-term results of a single-center randomized controlled trial comparing drug-coated balloon angioplasty (DBA) and plain balloon angioplasty (PBA) for the treatment of dysfunctional radiocephalic arteriovenous fistulas (RCAVFs). Materials and Methods In this prospective study, 39 patients (mean age, 62.2 years; 21 males, 18 females) with RCAVFs failing due to juxta-anastomotic stenosis were randomly assigned to undergo either both DBA and PBA (n = 20, DBA group) or PBA alone (n = 19, PBA group) between June 2016 and June 2018. Primary endpoints were technical and clinical success and target lesion primary patency (TLPP); secondary outcomes were target lesion secondary patency (TLSP) and complication rates. Statistical analysis was performed using the Kaplan-Meier product limit estimator. Results Demographic data and baseline clinical characteristics were comparable between the groups. Technical and clinical success rates were 100% in both groups. There was no significant difference between the groups in the mean duration of TLPP (DBA group: 26.7 ± 3.6 months; PBA group: 27.0 ± 3.8 months; p = 0.902) and TLSP (DBA group: 37.3 ± 2.6 months; PBA group: 40.4 ± 1.5 months; p = 0.585). No procedural or post-procedural complications were identified. Conclusion Paclitaxel-coated balloon use did not significantly improve TLPP or TLSP in the treatment of juxta-anastomotic stenosis of dysfunctional RCAVFs.

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Arteriovenous Access for Hemodialysis

Lok,

Huber,

Orchanian-Cheff

et al. 2024

JAMA

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ImportanceHemodialysis requires reliable vascular access to the patient’s blood circulation, such as an arteriovenous access in the form of an autogenous arteriovenous fistula or nonautogenous arteriovenous graft. This Review addresses key issues associated with the construction and maintenance of hemodialysis arteriovenous access.ObservationsAll patients with kidney failure should have an individualized strategy (known as Patient Life-Plan, Access Needs, or PLAN) for kidney replacement therapy and dialysis access, including contingency plans for access failure. Patients should be referred for hemodialysis access when their estimated glomerular filtration rate progressively decreases to 15 to 20 mL/min, or when their peritoneal dialysis, kidney transplant, or current vascular access is failing. Patients with chronic kidney disease should limit or avoid vascular procedures that may complicate future arteriovenous access, such as antecubital venipuncture or peripheral insertion of central catheters. Autogenous arteriovenous fistulas require 3 to 6 months to mature, whereas standard arteriovenous grafts can be used 2 to 4 weeks after being established, and “early-cannulation” grafts can be used within 24 to 72 hours of creation. The prime pathologic lesion of flow-related complications of arteriovenous access is intimal hyperplasia within the arteriovenous access that can lead to stenosis, maturation failure (33%-62% at 6 months), or poor patency (60%-63% at 2 years) and suboptimal dialysis. Nonflow complications such as access-related hand ischemia (“steal syndrome”; 1%-8% of patients) and arteriovenous access infection require timely identification and treatment. An arteriovenous access at high risk of hemorrhaging is a surgical emergency.Conclusions and RelevanceThe selection, creation, and maintenance of arteriovenous access for hemodialysis vascular access is critical for patients with kidney failure. Generalist clinicians play an important role in protecting current and future arteriovenous access; identifying arteriovenous access complications such as infection, steal syndrome, and high-output cardiac failure; and making timely referrals to facilitate arteriovenous access creation and treatment of arteriovenous access complications.

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Drug-Coated Balloon Angioplasty in Hemodialysis Circuits: A Systematic Review and Meta-Analysis

Cited by 65 publications

References 27 publications

Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials

Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials

Paclitaxel-Coated Balloon versus Plain Balloon Angioplasty for Dysfunctional Autogenous Radiocephalic Arteriovenous Fistulas: A Prospective Randomized Controlled Trial

Arteriovenous Access for Hemodialysis

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