Sirolimus-coated balloon angioplasty in maintaining the patency of thrombosed arteriovenous graft: 1-year results of a prospective study

Abstract

Background: A prospective, pilot study was designed to test the feasibility of using sirolimus-coated balloon (SCB) to treat graft vein junction of thrombosed arteriovenous graft (AVG) following successful pharmacomechanical thrombectomy. The present report provides the 1-year results of this study. Methods: This is a 1-year follow-up of a single, prospective, single-arm study that was conducted from 2018 to 2019 in 20 patients who presented to a tertiary institution with thrombosed AVG. The recruited patients received SCB angioplasty at the graft-vein junction following successful endovascular thrombectomy of a thrombosed AVG. One year after recruitment, there were three deaths, one AVG revision, and one AVG explantation among the participants recruited. The outcomes of 15 subjects at 1-year following the index procedure obtained from electronic medical records were re-examined. Results: The 1-year access circuit primary patency rate was 40%, while assisted primary and secondary patency rates were 46.7% and 73.3%, respectively. A total of 16 interventions (4 angioplasties, 12 thrombectomies) were performed in 9 patients over the 12 months. Four AVGs were abandoned. The median number of interventions per patient was 1 (0–3) per year. Using Kaplan-Meier analysis, the mean estimated post-intervention access circuit primary patency was 230 (95% CI: 162–300) days, while access circuit assisted primary patency was 253 (95% CI: 187–320) days, and access circuit secondary patency was 292 (95% CI: 230–356) days. Sub-group analysis did not show a significant difference in the mean estimated primary patency between AVG with de novo and recurrent stenosis (245 days, 95% CI: 151–339 vs 210 days, 95% CI: 113–307; p = 0.29). Conclusions: SCB may help sustain the patency of thrombosed AVG following successful thrombectomy.

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

“…In light of the 2018 reports regarding potential paclitaxel-associated mortality, DCBs and stents employing sirolimus as an anti-proliferative gained traction. Tan et al treated 20 patients with vein-graft anastomotic stenoses using a sirolimus DCB (MagicTouch, Concept Medical, India), with results demonstrating a 6-month ACPP of 65% and mean patency of 285 days ( 111 ). Twelve-month follow-up results demonstrated a ACPP of 40%.…”