Drug-Coated Versus Plain-Old Balloon Angioplasty in Percutaneous Arteriovenous Fistula Management

Sunday, March 5, 2023

3:09 PM – 3:18 PM

Location: Phoenix Convention Center, 222AB

Presenting Author(s)

TM

Tej I. Mehta, MD

Interventional Radiology Resident
Johns Hopkins Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

ML

Mark L. Lessne, MD

Vascular and Interventional Radiologist
Vascular & Interventional Specialists, Charlotte Radiology
RS

Robert Shahverdyan, MD

Physician
Asklepios Clinic Barmbek

Disclosure(s):

Tej I. Mehta, MD: No financial relationships to disclose

Mark L. Lessne, MD: ABBOTT, ANGIODYNAMICS, ANGIOSAFE, BD BARD, BOSTON SCIENTIFIC, CSI – FRONTIER, INTACT VASCULAR, ABBOTT, MEDTRONIC, MICRO MEDICAL SOLUTIONS, PLURISTEM, LTD SURMODICS, VERYAN, VESPER MEDICAL: Consultant (Ongoing), Speaking and Teaching (Ongoing); Baylis Medical Technologies: Speaking and Teaching (Ongoing); CARDIOVASCUAR SYSTEMS (CSI), CORDIS/CARDINAL HEALTH, INARI MEDICAL INC., INTACT VASCULAR, MEDTRONIC, PHILIPS, VESPER: Consultant (Ongoing); Merit Medical: Contracted Research (Ongoing); phillips/volcano/Spectranetics: Speaking and Teaching (Ongoing); Terumo: Speaking and Teaching (Ongoing)

Purpose: The purpose of this article is to report our experiences with plain-old balloon angioplasty (POBA) versus drug coated balloon angioplasty (DCBA) for maintenance of percutaneous arteriovenous fistulas (pAVFs).

Materials and Methods:

A prospectively collected database of all consecutive patients that underwent pAVF creation and required pAVF percutaneous angioplasty (PTA) to maintain patency at a single vascular access center between 08/27/2018 and 10/11/22 was retrospectively reviewed. All pAVFs were created by a single operator (RS). T-test and Cox proportional hazard ratios (HRs) were used to evaluate group differences and hazard of pAVF patency loss post-PTA, hazard of subsequent pAVF reintervention for those who received DCBA compared to those that received POBA. Patency loss was defined as reintervention, abandonment or conversion to alternative access. Reintervention was defined as any subsequent intervention to maintain patency.

Results:

96 patients underwent PTA post-pAVF creation; median time to first PTA was 141.5 days from creation. Mean patient age was 64 years, 39 patients had type 2 diabetes mellitus, 26 patients were female. Mean follow-up days post-pAVF creation was 902 (standard deviation 397 days). 74 patients underwent initial pAVF creation with Ellipsys, 22 with WavelinQ. Initial PTA was with POBA in 57 patients and 39 with DCBA. The most common PTA location was the juxtaanastomotic perforator (47%), followed by the juxtaanastomotic radial vein (8.3%), the juxtaanastomotic perforator and cephalic vein (6.2%), cephalic vein (5.2%) and other sites or combinations of sites (33.3%).

Patients who underwent PTA with DCBA had significantly greater patency rates (90% DCBA vs 68% POBA, P=0.02) and longer time to first PTA (236 days vs. 154 days, P< 0.01). There was no significant difference in PTA location between POBA and DCBA.

12 patency losses occurred in the DCBA group, 37 in the POBA group with median time to patency loss of 436 and 290 days respectively (HR=0.4, P< 0.01). Neither anastomosis site nor PTA site significantly affected time to patency loss.

11 reinterventions occurred in the DCBA group, 34 in the POBA group with median time to reintervention of 207 and 154 days respectively (HR=0.78, P=0.48). Significantly more patients in the POBA group underwent reintervention than in the DCBA group (P< 0.01).

Conclusion:

Patients undergoing initial pAVF PTA with DCBA had significantly greater patency rates, significantly more patients in the POBA group underwent reintervention; there was no significant difference in the time to reintervention compared to DCBA.