The Efficacy of Paclitaxel Drug-Eluting Balloon Angioplasty Versus Standard Balloon Angioplasty in Stenosis of Native Hemodialysis Arteriovenous Fistulas: An Analysis of Clinical Success, Primary Patency and Risk Factors for Recurrent Dysfunction.

Abstract

To investigate the efficacy of paclitaxel drug-eluting balloons (PEB) versus standard balloon angioplasty (BA) in stenosis of native hemodialysis arteriovenous fistulas (AVFs). A total of 96 patients with ESRD (mean ± SD age 57.0 ± 9.1years, 63.5% were males) who underwent endovascular treatment with PEB angioplasty (n = 32) and BA (n = 64) for a dysfunctional native AVF were included. Clinical success, complications, primary patency and postoperative recurrence parameters were recorded in each group. Primary patency rate at 6months was significantly higher in PEB than in BA group (96.9 vs. 20.3%, p < 0.001), while the two groups had similar primary patency rates at 9months (66.8 vs. 50.0%) and 12months (6.3% for each). No significant difference was noted between PEB and BA groups in terms of the rate (21.9% and. 31.3%), time (median 220 vs. 152.5days) and reasons (reocclusion in 18.8 vs. 28.1%) for dysfunction recurrence as well as the number of recurrent treatments. AVF dysfunction recurrence was more likely in younger age AVF (median 4 vs. 23months, p < 0.001 in PEB, and 8.5 vs. 20.5months p = 0.001 in SBA) and in AVF ≤ 6months in both SBA and PEB groups (71.4 vs. 12.0%, p = 0.005 in PEB, 40.0 vs. 2.3%, p < 0.001). In conclusion, our findings emphasize favorable safety and efficacy of PEB and BA in the management of dysfunctional hemodialysis AVFs with similar rates of post-PTA recurrence of AVF dysfunction. Nonetheless, there was a nonsignificant tendency for lower rate and a delay for recurrent dysfunction in patients treated with PEB and a significant association younger AVF age with an increased risk of post-PTA recurrence of AVF dysfunction. 3, Retrospective cohort study.