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Kidney Week

Abstract: PO1035

Feasibility of Treating Stenotic Fistula Lesions with a Drug-Coated Balloon Prior to Using a Standard High Pressure Balloon

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Author

  • Barnes, Sylvester, Edward Hines Junior VA Hospital, Hines, Illinois, United States
Background

Hemodialysis access maintenance is a major cost expenditure for dialysis care. Patients often require multiple procedures per year, often treating the same access lesion in a AVF / AVG. A large proportion of stenotic lesions develop secondary to neointimal hyperplasia. Standard treatment has been angioplasty using high pressure non-compliant balloons. Recently drug coated balloons (DCB), coated with the medication paclitaxel; to help decrease neointimal hyperplasia, have been used in dialysis access treatment. The safety profile and efficacy have been proven to decrease lesion reoccurrence at 6 months when compared to regular angioplasty. Traditionally the recommendation for use of DCB is to follow after the lesion has been primarily dilated with a high-pressure balloon (HPB).

Methods

For DCB use the manufacture recommends pretreatment of the lesion with a HPB followed by secondary DCB treatment. This Arthur decided to modify the technique and treat lesions needing angioplasty with DCB first (example in figure 1) and only secondary treatment with HPB if there was not sufficient resolution of the lesion / ballon inflation to acheive less than 30% residual stenosis. Observational data is being tracked for patients undergoing fistulograms to provide a single center observational prospective cohort to look into this issue.

Results

Currently 11 patients with 15 total lesions have undergone this modification of treatment in the past 9 months, with 3 of the 11 patients having repeat fistulograms post treatment. Nine of the 11 patients required no HPB follow up. One of the 11 patients suffered a cephalic arch rupture and required stent graft placement.

Conclusion

Early data from this observational study shows that treatment of a stenotic lesion using a DCB as the only treatment is effective in the majority of cases to achive full lesion angioplasty. Preliminary results indicate no change in long term efficacy in the DCB lesion treatment.