Stent graft placement versus angioplasty for hemodialysis access failure: a meta-analysis

Hu, Huanrui; Wu, Zhoupeng; Zhao, Jichun; Wang, Jiarong; Huang, Bin; Yang, Yi; Xiong, Fei

doi:10.1016/j.jss.2018.01.030

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…Furthermore, one group used an inverse variance fixed-effects model to calculate HRs. 6 Nevertheless, both studies and our results clearly favoured covered stents over angioplasty in terms of primary patency.…”

Section: Loss Of Secondary Patency In Failing Avgssupporting

confidence: 46%

Covered stents versus balloon angioplasty for failure of arteriovenous access: a systematic review and meta-analysis

Fugger

Onakpoya

et al. 2021

BMJ Open

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IntroductionPatients with end-stage renal disease may require arteriovenous (AV) access in the form of arteriovenous fistulae (AVFs) or arteriovenous grafts (AVGs) for haemodialysis. AV access dysfunction requires intervention such as plain balloon angioplasty or covered stents to regain patency.AimTo systematically review and meta-analyse the patency outcomes of covered stents in failing haemodialysis AV access, compared with balloon angioplasty.MethodsThe review was first registered on the International Prospective Register of Systematic Reviews (CRD42018069955) before data collection. We searched six electronic databases to identify relevant randomised controlled trials (RCTs) up until August 2020, without language restriction. Two reviewers assessed the suitability and quality of studies for inclusion using the Consolidated Standards of Reporting Trials guidelines. We meta-analysed data using a random-effects model.ResultsWe included seven studies including 1147 patients in the systematic review, of which 867 had AVGs and 280 had AVFs. One study was an ongoing RCT. In the meta-analyses, we assessed patients with failing AVGs only. Overall risk of bias was moderate. Covered stents were associated with lower loss of patency versus angioplasty alone at 6, 12 and 24 months (OR 4.48, 95% CI 1.98 to 10.14, p<0.001; OR 4.07, 95% CI 1.74 to 9.54, p=0.001; OR 2.24, 95% CI 1.17 to 4.29, p=0.01, respectively). Covered stents afforded superior access circuit primary patency compared with angioplasty alone at 6 and 12 months (OR 1.91, 95% CI 1.31 to 2.80, p<0.001; OR 1.97, 95% CI 1.14 to 3.41, p=0.02, respectively). This was not significant at 24 months. There was no significant difference in loss of secondary patency between groups at 12 or 24 months (OR 0.74, 95% CI 0.45 to 1.23, p=0.25; OR 0.67, 95% CI 0.29 to 0.154, p=0.34, respectively).ConclusionOur results support use of covered stents over angioplasty alone, at 6, 12 and 24 months in failing AVGs. Further clinical trials are warranted.

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Section: Loss Of Secondary Patency In Failing Avgssupporting

confidence: 46%

Covered stents versus balloon angioplasty for failure of arteriovenous access: a systematic review and meta-analysis

Fugger

Onakpoya

et al. 2021

BMJ Open

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“…Two recent, conventional metaanalyses of RCTs reported that standard angioplasty combined with SG was significantly superior to BA alone in thrombosed or failing prosthetic AVGs. 24,40 The superiority of SG over plain BA has also been shown in the recent RESCUE trial in treating in stent restenosis too. 27 However, other endovascular techniques including cutting balloons, angioplasty combined with STs, and DEBs have never been directly compared with SG use.…”

Section: Discussionmentioning

confidence: 83%

Short Term Success of Treatments to Salvage Thrombosed or Failing Synthetic Arteriovenous Grafts in End Stage Renal Disease: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

Nikolopoulos

Yiallourou

Argyriou

et al. 2019

European Journal of Vascular and Endovascular Surgery

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This article used network meta-analysis to indirectly estimate differences between treatments to salvage thrombosed/failing synthetic arteriovenous grafts in end stage renal disease that have not been compared head to head. The synthesis of existing evidence showed that stent grafts perform better than balloon angioplasty in decreasing the failure risk at three months. The drug eluting balloon was ranked high as the best treatment, but the evidence stems from one small study and most comparative effect estimates were not statistically significant. Objective: There is currently uncertainty regarding the ideal treatment to salvage thrombosed or failing synthetic arteriovenous grafts (AVGs) in patients with end stage renal disease. Therefore, a systematic review up to December 2018 and network meta-analysis of randomised control trials (RCTs) that compared three month failure risk of available treatments was carried out. Methods: Medline, Scopus, Embase, and the Cochrane Library were the data sources. Pairwise meta-analyses were based on random effects models. Network meta-analysis was conducted within a frequentist framework with a multivariable random effects approach to model treatment effects across studies. The metric of choice was the odds ratio (OR) along with the associated 95% confidence interval (CI). Results: Sixteen two arm RCTs were included involving 2011 patients who were randomised to six different treatments (plain balloon angioplasty, open surgical repair, stents, stent grafts, drug eluting balloons (DEBs), and cutting balloons). The network of RCTs had a star like geometry with plain balloon angioplasty being the common comparator. There were no significant differences between treatments with regards to risk of failure at three months with the exception of stent graft use that significantly reduced the risk of failure compared with plain balloon angioplasty (OR 0.53, 95% CI 0.34e0.84). Based on surface under the cumulative ranking curve (SUCRA) values, the best interventions to salvage thrombosed or failing AVGs were DEB and stent grafts. Conclusions: Stent graft seems to perform better than plain balloon angioplasty in terms of saving thrombosed or failing AVGs. However, this network meta-analysis was limited by the lack of closed loops and thus unable to assess consistency between direct and indirect evidence. The efficacy of DEBs as a promising treatment deserves further investigation and new RCTs are required.

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“…For bare metal stents, the intima continues to be exposed to turbulent flow and biochemical constituents of blood vessels through the interstices [ 18 ]. This may explain why lower restenosis rates were seen for stent grafts that cover the intima with a physical barrier while propping open the vessel lumen, nonetheless, the intima at the ends of stent grafts remains exposed and hyperplasia can be a point of recurrent stenosis due to the same reasons [ 19 , 20 ]. Although not evaluated, several incidences of stent fracture were noted as causing recurrent stenosis; oftentimes, angioplasty and/or stenting was required to improve the flow and appearance.…”

Section: Discussionmentioning

confidence: 99%

Cephalic arch restenosis rates in hemodialysis patients with brachiocephalic fistulae: a retrospective multicenter analysis of 3301 patients

Razdan¹,

Rosenblatt²,

Jiao

et al. 2022

BMC Nephrol

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Background We evaluated restenosis rates at the cephalic arch after percutaneous angioplasty and stenting procedures in patients with brachial artery to cephalic vein arteriovenous fistula (BCAVF) hemodialysis access. Methods We used data from adult hemodialysis patients treated at a national network of 44 outpatient interventional facilities during Oct 2011–2015. We included data from patients with BCAVF who received an exclusive angioplasty, or stent with angioplasty, for treatment of cephalic arch stenosis and had ≥1 subsequent evaluation of the cephalic arch. Median percent restenosis per month at cephalic arch and days between encounters was calculated from the 1st index to 2nd procedure, and for up to 4 subsequent encounters. Analyses were stratified by intervention and device types. Results We identified a cohort of 3301 patients (mean age 62.2 ± 13.9 years, 58.5% male, 33.2% white race) with a BCAVF who had an angioplasty, or stent, at the cephalic arch for an index and ≥ 1 follow-up procedure. Between the 1st index to 2nd procedure, patients who received an angioplasty (n = 2663) or stent (n = 933) showed a median decrease of 18.9 and 16.5% in luminal diameter per month and a median time of 93 and 91 days between encounters, respectively. Restenosis and day rates were similar for standard versus high-pressure angioplasties. Bare metal stents showed 10.1 percentage point higher restenosis rate compared to stent grafts. Restenosis rates and time to restenosis were relatively consistent across subsequent encounters. Conclusions Findings suggest hemodialysis patients with a BCAVF who require an angioplasty or stent to treat a stenosis at the cephalic arch will have stenosis reformed at a rate of 18.9 and 16.5% per month after the first intervention, respectively. Findings suggest patients are at risk of having significant lesions at the cephalic arch within 3 months after the previous intervention.

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Stent graft placement versus angioplasty for hemodialysis access failure: a meta-analysis

Cited by 16 publications

References 19 publications

Covered stents versus balloon angioplasty for failure of arteriovenous access: a systematic review and meta-analysis

Covered stents versus balloon angioplasty for failure of arteriovenous access: a systematic review and meta-analysis

Short Term Success of Treatments to Salvage Thrombosed or Failing Synthetic Arteriovenous Grafts in End Stage Renal Disease: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

Cephalic arch restenosis rates in hemodialysis patients with brachiocephalic fistulae: a retrospective multicenter analysis of 3301 patients

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