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Kidney Week

Abstract: TH-OR143

Comparison of Drug-Coated Balloon Angioplasty vs. Conventional Balloon Angioplasty for Arteriovenous Fistula Stenosis: A Meta-Analysis

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Abdul Salim, Sohail, University of Mississippi Medical Centre, Brandon, Mississippi, United States
  • Thongprayoon, Charat, Mayo Clinic, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Centre, Brandon, Mississippi, United States
  • Fulop, Tibor, Medical University of South Carolina , Charleston, South Carolina, United States
Background

Arteriovenous fistula (AVF) is the most preferred form of vascular access for maintenance hemodialysis (HD) but access stenosis treated by balloon angioplasty are prone to restenosis due to neointimal proliferation. Multiple trials have been published with regards to use of paclitaxel coated balloon (DCB) to prolong lesion patency when compared to conventional balloon. Though DCB has theoretical appeal, its use has not been widespread with access centers nationwide due to factors related to cost and lack of large scale multicenter studies. We performed this meta-analysis to evaluate whether use of DCB outperforms conventional balloon to prolong target lesion patency.

Methods

Medical electronic databases, including PubMed/Medline, Clinical Trials.gov, EMBASE, Scopus, Web of Science and Cochrane Central were searched from inception through April 2019 for studies that investigated use of DCB in HD AVF. 15 studies (6 Randomized control trials (RCT) and 9 observational studies) were considered for qualitative and quantitative analysis.

Results

Ten studies were included in the final meta-analysis. 6 of the studies were RCTs and 4 were retrospective (cohort) studies. There were 915 participants with a mean age of 65.40 (+/-5.96) years and 61.89% were male. The outcome of interest was target lesion primary patency (TLPP), recorded at a longitudinal follow-up time, i.e. 1, 3, 6, 7, 12 and 24 months. Meta-analysis of all RCTs shows that drug-coated balloons (DCBs) did not statistically improve TLPP compared to traditional balloons at months 1 (OR 4.27, p-value 0.06), 3 (OR 0.9, p-value0.99), 6 (OR 0.80, p-value 0.54), 7 (OR 0.93, p-value 0.75), 12 (OR 0.61, p-value 0.17) and 24 (OR 0.69, p-value 0.15). The effect of DCBs was statistically significant for cohort studies at 6 months (OR 0.26, p-value 0.0007), 12 months (OR 0.21, p-value 0.0001) and 24 months (OR 0.23, p-value 0.01). Studies using AV-Graft were excluded. There was no publication bias as assessed by funnel plots.

Conclusion

Drug-coated balloons showed no statistically significant improvement over conventional balloons in decreasing fistula stenosis in meta-analysis of RCT at 1,3,6,7,12 and 24 months but were significant for cohort studies at all follow up months of 6, 12 and 24. Our analysis does not justify the use of DCB at this time.