Cutting balloon angioplasty versus conventional balloon angioplasty in hemodialysis access stenoses: Multicenter prospective randomized comparison of primary patency rates.

Abstract

Purpose: To compare primary patency rates of cutting balloon percutaneous transluminal angioplasty and conventional balloon percutaneous transluminal angioplasty in the treatment of different types of hemodialysis access stenosis. Patients and methods: 58 patients with different types of hemodialysis access stenosis in whom PTA was indicated were prospectively, randomized to have either conventional balloon percutaneous transluminal angioplasty or cutting balloon percutaneous transluminal angioplasty The study was performed at 3 medical centers in Saudi Arabia {Al-Moosa Specialized hospital Al-Ahsaa, Tabuk University, & Saudi German Hospital Riyadh). The primary patency rates of conventional PTA group & cutting balloon PTA group were compared The patients were followed up for 15 months. Primary patency rates for lesions were calculated with the Kaplan-Meier method according to the type of stenosis.compared the two groups by using the log-rank test to determine statistical significance. Results: In the cutting PTA group, 26 patients with 29 stenoses achieved clinical success. In the conventional PTA group, 25 patients with 30 stenoses achieved clinical success. In patients with graft-to vein anastomotic stenosis, the primary patency rate was significantly higher for cutting PTA than for conventional PTA (P = .037).In patients with autogenous venous stenosis, intragraft stenosis and arterial anastomotic stenosis, no significant difference in the primary patency rate was noted between groups (P = .360, .371 & .921 respectively). Conclusion: Primary patency rates are significantly higher for cutting PTA in the treatment of graft-to-vein anastomotic stenosis, however, no significant differences in primary patency rates exist between these PTAs in the treatment of autogenous venous stenosis, intragraft stenosis, or arterial anastomotic stenosis.