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Drug-coated balloons (DCBs) has emerged as a new endovascular treatment for arteriovenous fistula (AVF) stenosis for their ability to combat neointimal hyperplasia (NIH) and improve target lesion primary patency rates (TLPP). However, there have been inconsistencies in benefits of DCB in clinical trials to date. We postulate that stenosis with neointimal hyperplasia seen on ultrasound scan will respond better to anti-proliferative effect of DCB compared to constrictive stenosis treated with DCB versus plain old balloon angioplasty (POBA).
This is a retrospective analysis from a single-centre. 56 patients who underwent angioplasty of dysfunctional AVF following diagnostic ultrasound to determine the sites and types of stenosis were included. All lesions were categorized to NIH group or constrictive stenosis group depending on ultrasonographic characteristics. TLPP of the lesions with DCB vs POBA were investigated.
A total of 83 lesions were included in the analysis. Of which, 55% were NIH and 45% were constrictive stenosis. The TLPP for NIH typed stenosis treated with DCB vs POBA was 42.3% vs 10.0% at 6-months (p =0.062), while the TLPP for constrictive stenosis was 60.0% vs 33.3% (p =0.017) at 6-months, respectively. Kaplan-Meier analysis demonstrated estimated mean TLPP of 423 vs 267 days (95%CI 167-540, log-rank p =0.062) for NIH typed lesions treated with DCB vs POBA and TLPP of 563 vs 220 days (95%CI 147-755, log-rank p =0.017) for constrictive stenosis treated with DCB vs POBA.
AVF stenosis with both NIH and constrictive stenosis morphology on ultrasound respond better to DCB compared to POBA.