Comparison of Outcomes of Drug-Coated Balloons vs Plain Balloons in Secondary Interventions on Percutaneous Arteriovenous Fistulae

Robert Shahverdyan; Mark L Lessne; Tej Ishaan Mehta

doi:10.1016/j.jvir.2024.04.014

Comparison of Outcomes of Drug-Coated Balloons vs Plain Balloons in Secondary Interventions on Percutaneous Arteriovenous Fistulae

J Vasc Interv Radiol. 2024 Apr 27:S1051-0443(24)00318-X. doi: 10.1016/j.jvir.2024.04.014. Online ahead of print.

Authors

Robert Shahverdyan¹, Mark L Lessne², Tej Ishaan Mehta³

Affiliations

¹ Vascular Access Center, Asklepios Clinic Barmbek, Hamburg, Germany. Electronic address: robert.shahverdyan@icloud.com.
² Vascular & Interventional Specialists, Charlotte Radiology; Charlotte, NC, United States; The Johns Hopkins Hospital, Department of Radiology, Baltimore, MD, United States.
³ The Johns Hopkins Hospital, Department of Radiology, Baltimore, MD, United States.

PMID: 38685469
DOI: 10.1016/j.jvir.2024.04.014

Abstract

Purpose: To compare patency and reintervention outcomes following either POBA or DCBA for venous stenoses after percutaneous AV fistula creation.

Materials and methods: One-hundred and ninety-five pAVFs were successfully created during the study period; 141 using Ellipsys® and 54 using WavelinQ^TM. Post pAVF creation, 95 patients (48.7%) required secondary PTA with either POBA (n=55, 58%) or DCBA (n=40, 42.1%). The most common site for PTA was the juxta-anastomotic segment (75.5%; 74/98). Univariate and multivariate Cox regression analyses were used to compare target lesion primary patency, access circuit primary patency, secondary patency, and reintervention rates in the POBA and DCBA cohorts.

Results: In the POBA cohort 34/55 (62%) patients and in the DCBA cohort 14/40 (35%) of patients required reinterventions for pAVF re-stenosis. Mean follow up days amongst patients treated with POBA was 1030.4 (standard deviation: 342.9) and amongst those treated with DCBA was 744.4 (standard deviation: 403.5). The use of POBA compared to DCBA was not associated with target lesion and access circuit primary patency loss in multivariate analysis (HR=1.81, P=0.080, 95%CI=0.93-3.51 and HR=1.77, P=0.210, 95%CI=0.73-4.28 respectively). However, time from fistula creation to the first PTA (days) was significantly associated with both outcomes (HR=0.997, P=0.009, 95%CI=0.994-0.999 and HR=0.997, P=0.021, 95%CI=0.992-0.999 respectively). There were no major adverse events.

Conclusions: In this retrospective single-center analysis of pAVFs, significantly more patients who underwent PTA with POBA post pAVF-creation required reinterventions as compared to PTA using DCBA, although the follow-up time of POBA was longer. In multivariate analysis no significant differences were noted in the hazard of patency loss between POBA and DCBA.