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Kidney Week

Abstract: FR-PO495

Time-Dependent Efficacy of Percutaneous Angioplasty with Drug-Coated Balloon in the Treatment of Stenosis of Artero-Venous Fistulae: A Retrospective Study

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Morganti, Claudia, Universita degli Studi di Parma Dipartimento di Medicina e Chirurgia, Parma, Emilia-Romagna, Italy
  • Fiaccadori, Enrico, Universita degli Studi di Parma Dipartimento di Medicina e Chirurgia, Parma, Emilia-Romagna, Italy
  • Bedogni, Stella, Universita degli Studi di Parma Dipartimento di Medicina e Chirurgia, Parma, Emilia-Romagna, Italy
  • Di Motta, Tommaso, Universita degli Studi di Parma Dipartimento di Medicina e Chirurgia, Parma, Emilia-Romagna, Italy
  • Maggiore, Umberto, Universita degli Studi di Parma Dipartimento di Medicina e Chirurgia, Parma, Emilia-Romagna, Italy
Background

Percutaneous transmural angioplasty (PTA) is the first-line treatment for stenosis of the arteriovenous fistulae (AVF). Even if paclitaxel drug-coated balloon (DCB) has become the standard of care, trials testing efficacy in comparison with standard PTA has provided conflicting results. We tested the hypothesis that conflicting findings from trials may result from the effect of DCB being short-lived.

Methods

We enrolled all patients undergoing angioplasty AVF stenosis with PTA or DCB 01/2011 to 04/2022 at the Parma dialysis centre. The choice of PTA vs. DCB depended on the temporary supply of each device. AVF patency was assessed after the procedure and at monthly intervals until month 12. We compared the hazard of AVF failure using interval-censored Cox-multiple regression model, with the procedure (DCB vs. PTA) being included as a time-varying effect (i.e. interacted with time), and the standard errors adjusted for accounting of multiple procedures within the same patient.

Results

We retrospectively examined 146 procedures (in 143 subjects), 69 with PTA and 77 with DCB. Baseline features were similar between groups, apart from DCB performed most often in patients with multifocal stenosis (22.1 vs. 1.4%; P<0.001) and with previous AVF (76.6 vs. 58%; P=0.021), but less often with cardiovascular disease (46.8 vs. 69.6%; P=0.007). Figure 1 shows crude AVF patency over the follow-up: survival curves diverged shortly after the procedure and eventually converged. Adjusted for different variables, the hazard of AVF failure was halved with DCB compared to PTA after the procedure (adjusted hazard ratio aHR 0.48 [95%CI: 0.26-0.97; P=0.016]); then, benefit vanish over time and aHR increasing (toward the null value of 1) by 1.20 per every month elapsed since the procedure (95%CI: 1.07-1.34; P=0.001).

Conclusion

Compared to PTA, DCB provides significant short-term benefit which vanishes by 12 months after the procedure.