Paclitaxel‐coated balloon in the treatment of recurrent dysfunctional arteriovenous access, real‐world experience and longitudinal follow up

Abstract

Aim Dysfunctional arteriovenous (AV) access remains a significant cause of morbidity and hospital admission for patients with end stage renal failure on haemodialysis. This study was performed to evaluate the impact of paclitaxel‐coated Balloon (PCB) on the patency of AV access with recurrent stenoses. Methods We retrospectively studied haemodialysis patients who presented to our centre with recurrent AV access dysfunction and compared intervention‐free patency using plain balloon versus PCB. Results A total of 147 patients were followed up longitudinally. Intervention‐free patency was better following PCB compared to previous intervention using plain balloons (6.4 ± 5.8 versus 4.0 ± 3.7, P < 0.01). The 3‐ and 6‐month patency rates after PCB were significantly better compared to standard plain angioplasty balloon: 69.4% versus 52.4%, P < 0.01 and 42.9% versus 15.6%, P < 0.01 respectively. Kaplan–Meier survival analysis of circuit patency demonstrated the superiority of PCB over plain balloon angioplasty in both arteriovenous fistula and arteriovenous graft (P < 0.01 and P = 0.01 respectively) although the patency of arteriovenous fistula remained significantly better than arteriovenous graft following interventions with PCB (P < 0.01). Age of AV access and the number of previous interventions were found to be significant predictors of patency following PCB intervention. Conclusion Arteriovenous access intervention with PCB was shown to be superior compared to plain balloon in the treatment of both non‐thrombosed and thrombosed AV accesses in our multi‐ethnic population.

Efficacy of High-Pressure Balloon for the Treatment of Arteriovenous Fistula Stenosis: A Meta-Analysis

“…Previous studies have demonstrated that DCB and CtB are superior to conventional balloon (CB) in terms of AVF stenosis. [2][3][4] However, studies comparing the effects of HPB and CB were scarce. Therefore, we conducted a meta-analysis to investigate the clinical effectiveness of HPB against CB for patients with AVF stenosis.…”

Longitudinal micro‐incision creation prior to balloon angioplasty for treatment of arteriovenous access dysfunction in a real‐world patient population: 6‐month cohort analysis

“…21 Supporting Information Table S1 summarizes the literature comparison results. 6,[20][21][22][23] The observation of comparable target lesion primary patency in the FLEX-AV registry relate to those reported by RCTs is remarkable given that inclusion criteria for RCTs are more stringent than those for this allcomers registry. Thus, the results provide reinforcement for the benefit of FLEX VP prior to PTA for vascular access treatment.…”

Novel Approaches to Arteriovenous Access Creation, Maturation, Suitability, and Durability for Dialysis

“…These data were confirmed in a longitudinal follow-up of 147 patients. 49 There has been concern about morbidity and mortality with DCB; however, a recent meta-analysis, ILLUMENATE, found mortality rates for patients treated with DCB and uncoated PTA were indistinguishable over 3-year follow up. 50 Certainly, additional studies are needed.…”