Effectiveness of paclitaxel-coated balloon angioplasty in prolonging arteriovenous fistula patency: A retrospective analysis from a single center in Latin America.

Abstract

IntroductionArteriovenous fistula (AVF) is the preferred method for vascular access. However, fistulas can fail and may develop stenosis. Therefore, maintaining the patency of the access is vital. Balloon angioplasty has been accepted as the first-line treatment for central venous stenosis. However, the reintervention rate with plain balloon angioplasty (PBA) is high. Drug-coated balloons (DCB) have emerged as a promising therapy for effectively prolonging the patency of treated vessels and reducing the reintervention rate. This study aims to determine the 12-month patency of arteriovenous fistulas following paclitaxel-coated balloon (PCB) angioplasty for central and peripheral venous stenosis.MethodsThis single-center retrospective analysis included patients with end-stage renal disease who underwent hemodialysis via native arteriovenous fistulas. The information was collected from medical records and compiled into a de-identified database provided by the institution. All patients were included regardless of sex or age, provided they had an angiography demonstrating central or peripheral venous stenosis and were treated with PCB. Patients were followed up every 3 months for 12 months at the vascular center. The primary objective was to ensure the vascular access was functioning effectively for hemodialysis and to monitor for any complications.ResultsA total of 137 patients with AVF dysfunction were treated with PCB; among them, 111 (81%) had central venous stenosis and 26 (19%) had peripheral venous stenosis. There was no significant difference in patency rates at 12-month follow-up between central (79%) and peripheral (85%) accesses. Factors associated with non-patency at 12-month follow-up were exhausted access (HR = 0.21, 95% IC 0.09-0.47, p < .001) and stenosis length greater than 20 mm (HR = 0.33, 95% IC 0.15-0.72, p = .005).ConclusionsThe high patency rate at 12 months for dysfunctional AVFs indicated that treatment with PCB is highly effective in both central and peripheral vein stenosis.