Freeway paclitaxel-releasing balloons to treat recurrent stenosis of arteriovenous fistula in hemodialysis patients

Troisi, Nicola; Frosini, Piefrancesco; Romano, Eugenio; Guidotti, Azzurra; Chisci, Emiliano; Michelagnoli, Stefano

doi:10.23736/s0026-4725.17.04534-0

Cited by 3 publications

(5 citation statements)

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“…Time to loss of TLPP was 4.8 months after POBA leading into DCB treatment, and 7.6 months after DCB treatment (P<0.001). Two-year primary patency rates were 32% after DCB treatment ( 95 ). In a 2015 study which pre-empted their RCT, Swinnen et al retrospectively reviewed 37 cases in which a DCB (IN.PACT) was used to treat in-stent restenosis, with a significant difference in “re-intervention free percentage at 12 months” before and after DCB use, determined using the disease-free interval prior to DCB use and comparing it to the disease free-interval after DCB use.…”

Section: Additional Smaller Rcts Non-randomized Prospective Studies A...mentioning

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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Section: Additional Smaller Rcts Non-randomized Prospective Studies A...mentioning

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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“…Angioplasty mechanically stretches the vein and compresses the intima but may cause significant injury to the vessel. Although efficacious in the short-term, PTA frequently requires reintervention within one or two years after the first angioplasty procedure either due to regrowing of occlusive IH and/or fibrotic scarring of the AVF wall (8)(9)(10)(11)(12)(13)(14). Stent placement is the last line of treatment for recurrent and high recoil stenoses due to concerns of vein depletion, stent migration or fracture, and intrastent thrombosis (88,89).…”

Section: Current Challenges In Treating Avf Stenosis: a Call For Mechanism-based Approachesmentioning

confidence: 99%

“…Multiple individual studies have shown patency and/or re-intervention benefits of DEB vs. conventional angioplasty (12)(13)(14)(92)(93)(94)(95). However, meta-analysis studies have yielded variable conclusions, and patency rates over six months still have much room for improvement (96)(97)(98)(99).…”

Section: Current Challenges In Treating Avf Stenosis: a Call For Mechanism-based Approachesmentioning

confidence: 99%

“…In an attempt to improve postprocedure patency, antiproliferative drugs (mainly paclitaxel) are delivered to the AVF wall by means of drug-eluting balloons (DEB) or stents. Multiple individual studies have shown patency and/or reintervention benefits of DEB versus conventional angioplasty (12)(13)(14)(92)(93)(94)(95). However, meta-analysis studies have yielded variable conclusions, and patency rates .6 months still have much room for improvement (96)(97)(98)(99).…”

Section: Current Challenges In Treating Avf Stenosis: a Call For Mech...mentioning

confidence: 99%

“…The actual contribution of IH in relation to other transformation processes in the wall after AVF creation remains uncertain (7). Importantly, once stenosis becomes a pathology it is not easily treatable, with frequent recurrences after endovascular procedures (8)(9)(10)(11)(12)(13)(14). The lack of more effective therapies against stenosis reflects our simplistic view of the processes of intimal expansion and wall remodeling, and our unawareness of the characteristics that distinguish between benign and occlusive IH.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intimal Hyperplasia and Arteriovenous Fistula Failure: Looking Beyond Size Differences

et al. 2021

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The development of venous intimal hyperplasia (IH) has been historically associated with failure of arteriovenous fistulas (AVF) used for hemodialysis. This long-standing assumption, based on histological observations, has been recently challenged by clinical studies indicating that the size of the intima by itself is not enough to explain stenosis or AVF maturation failure. Irrespective of this lack of association, IH is present in most native veins and fistulas, is prominent in many cases, and suggests a role in the vein that may not be reflected by its dimensions. Therefore, the contribution of IH to AVF dysfunction remains controversial. Using only clinical data and avoiding extrapolations from animal models, we critically discuss the biological significance of IH in vein remodeling, vascular access function, and the response of the venous wall to repeated trauma in hemodialysis patients. We address questions and pose new ones such as: What are the factors that contribute to IH in pre-access veins and AVFs? Do cellular phenotypes and composition of the intima influence AVF function? Are there protective roles of the venous intima? This review explores these possibilities, with hopes of rekindling a critical discussion about venous IH that goes beyond thickness and AVF outcomes.

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Drug-Coated Balloons for the Dysfunctional Vascular Access: An Evidence-Based Road Map to Treatment and the Existing Obstacles

Kitrou

Κατσάνος

Georgopoulou

et al. 2022

Semin intervent Radiol

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An underlying stenosis within the venous limb of a hemodialysis access circuit is the main etiology for graft and fistula dysfunction as well as other symptoms such as arm, breast, and neck swelling. Treatment options for both peripheral and central venous stenoses include plain old balloon angioplasty, angioplasty with drug-coated balloons, and stenting. This article discusses the current evidence for the use of drug-coated balloon angioplasty in this patient population.

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Freeway paclitaxel-releasing balloons to treat recurrent stenosis of arteriovenous fistula in hemodialysis patients

Cited by 3 publications

References 0 publications

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

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

Intimal Hyperplasia and Arteriovenous Fistula Failure: Looking Beyond Size Differences

Drug-Coated Balloons for the Dysfunctional Vascular Access: An Evidence-Based Road Map to Treatment and the Existing Obstacles

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