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• W4280490529 abstract "Recent randomized trial data comparing drug-coated balloon (DCB) versus standard percutaneous transluminal angioplasty (sPTA) in stenotic lesions of dysfunctional, autogenous arteriovenous fistulas has demonstrated the superiority of drug-coated devices. Strict limitations in terms of lesion type, size, length, comorbidity and location, however (as is common for randomized trials), make the results less applicable to real-world patients. The objective of this study was to evaluate the efficacy of DCB compared with sPTA for dysfunctional arteriovenous fistulae, including non-de-novo lesions and the presence of stents within the circuit. An institutional review board-approved single-center retrospective review was performed to identify consecutive patients who underwent DCB or sPTA from January 2019 to June 2020 in dysfunctional, autogenous arteriovenous fistulas, including those with central venous stenosis or outflow stents. The primary outcome was target lesion primary patency at 6 months or freedom from reintervention. A total of 65 patients were identified and 44 patients underwent DCB versus 21 patients with sPTA. Balloon diameters and lengths ranged from 4 to 14 mm and 20 to 140 mm, respectively. There were no significant differences in co-morbidities or lesion characteristics between DCB and sPTA (Table I). Following the index procedure, lesions treated with DCB were more likely to be patent at 6 months when compared with sPTA (64.1% vs 28.6%; difference in risk 38%; P < .05) (Table II). While not statistically significant, the trend toward superior outcomes with DCB was also seen in the central venous lesions cohort (n = 17) (58.3% vs 20%; difference in risk 38.%; P > .05) (Fig 2). This real-world experience including outflow stents and central venous lesions, contributes to the body of literature demonstrating the superiority of DCB compared with sPTA in the treatment of stenotic arteriovenous fistula lesions.Table IDemographics, preoperative and operative characteristicsDCB (n = 44)sPTA (n = 21)P valueOverall (n = 65)Demographics Age63 ± 2.559 ± 16.4<.0561.7 ± 2 Male21 (47)11 (52)32 (49) Hispanic8 (18.2)1 (4.8)9 (13.9) RaceWhite12 (27.3)6 (28.6)18 (27.7)Black5 (11.4)8 (38.1)13 (20)Asian American/Pacific Islander18 (40.9)6 (28.6)24 (36.9) Hypertension42 (95.5)20 (95.2)62 (95.4) Hyperlipidemia31 (70.5)15 (71.4)46 (70.8) Diabetes mellitus28 (63.6)13 (61.9)41 (63.1) Congestive heart failure6 (13.6)4 (19)10 (15.4) Coronary artery disease10 (22.7)8 (38.1)18 (27.7) Former smoker16 (36.4)8 (38.1)24 (36.9)Preoperative characteristics Mean No. of prior interventions (lesion)2.252.24.962.26 Mean No. of prior interventions (circuit)1.571.43.851.47 Mean time from AVF creation to intervention, days1152.5798.9.061038.2Operative characteristics Central venous stenosis12 (27.3)5 (23.8).0817 (26.2) Outflow stent9 (20.5)2 (9.5).2711 (26.9) Lesion locationProximal/juxta-anastomotic10 (22.7)8 (38.1).2718Mid-outflow14 (31.8)3 (14.3)17Cephalic arch8 (18.2)5 (23.8)13Subclavian vein10 (22.7)2 (9.5)12Innominate vein1 (2.3)1 (4.8)2Superior vena cava1 (2.3)2 (9.5)3AVF, Arteriovenous fistula; DCB, drug-coated balloon; sPTA, standard percutaneous transluminal angioplasty. Open table in a new tab Table IIEffectiveness and safety end pointsDCBPOBADifference (95% CI)P valuePrimary effectiveness end point Target lesion primary patency at 6 months26/44 (64.1)6/21 (28.6)38 (12.01 to 57.09).0043 Target central venous lesion primary patency at 6 months7/12 (58.3)1/5 (20)38.3 (–11 to 66).1619Safety end point 30-Day adverse events involving the arteriovenous access circuit00CI, Confidence interval; DCB, drug-coated balloon; POBA, plain old balloon angioplasty. Open table in a new tab" @default.
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• W4280490529 date "2022-06-01" @default.
• W4280490529 modified "2023-09-30" @default.
• W4280490529 title "Real-world Experience With Drug-coated Balloon Angioplasty in Dysfunctional Arteriovenous Fistulae" @default.
• W4280490529 doi "https://doi.org/10.1016/j.jvs.2022.03.673" @default.
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