Plain versus drug-eluting balloon angioplasty in the treatment of non-thrombotic hemodialysis arteriovenous fistula stenosis: results from a single center comparative retrospective analysis.

Abstract

Purpose: To compare the mid-term primary and assisted-primary patency results of plain balloon angioplasty (PBA) versus drug-eluting balloon angioplasty (DEB) with non-thrombotic arteriovenous fistula (AVF) stenosis in hemodialysis (HD) patients.

Subject and methods: A total of 128 consecutive HD patients, who underwent endovascular treatment with DEB or PBA between October 2015 and December 2021, were investigated in this retrospective study. Color Doppler examination was performed for follow-up after 1, 3, 6, 12, 18, 24, and 36 months. Survival curves for primary and assisted primary vein patencies of the PTA and DEB group were generated with Kaplan-Meier survival analysis and were compared with the log-rank test.

Results: 78 patients (60.9%) underwent PBA (45 men, 33 women; mean age: 64.2 ± 13.9, range: 29-82 years) and 50 (39%) patients underwent DEB (36 men, 14 women; mean age: 65.6 ± 12.8, range: 28-87 years). The estimated primary patency rates at 6, 12,18, 24, and 36 months for the DEB group (95.5%, 92.8%, 88.6%, 77.1% and 54.0%, respectively) were significantly higher than those in the PBA group (84.5%, 76.9%, 73.9%, 66.4% and 59.0%, respectively) (p = .048). Assisted primary patency rates at 6, 12, 18, 24, and 36 months were higher in the DEB group (97.9%, 95.4%, 90.2%, 87.3% and 75.5%, respectively) than PBA group (94.7%, 86.9%, 85.0%, 78.0%, and 66.9%, respectively) but they were not statistically significant (p = .187).

Conclusion: Our study confirms DEB is a safe and effective treatment of dysfunctional AVF. We demonstrate higher primary patency rates in DEB than PBA at 6, 12, 18, 24 and 36 months. However, no statistically significant were detected between the two groups in mid-term follow-up.