Percutaneous Angioplasty Using a Paclitaxel-Coated Balloon Improves Target Lesion Restenosis on Inflow Lesions of Autogenous Radiocephalic Fistulas: A Pilot Study

• Published in: Journal of vascular and interventional radiology Vol. 25; no. 4; pp. 535 - 541
• Main Authors: Lai, Chi-Cheng, MD, Fang, Hua-Chang, MD, Tseng, Ching-Jiunn, MD, PhD, Liu, Chun-Peng, MD, Mar, Guang-Yuan, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2014
• Subjects: Aged; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Arteriovenous Shunt, Surgical - adverse effects; Cardiovascular Agents - administration & dosage; Chi-Square Distribution; Coated Materials, Biocompatible; Female; Graft Occlusion, Vascular - diagnosis; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - therapy; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Paclitaxel - administration & dosage; Pilot Projects; Prospective Studies; Radial Artery - diagnostic imaging; Radial Artery - physiopathology; Radial Artery - surgery; Radiography; Radiology; Recurrence; Renal Dialysis; Time Factors; Treatment Outcome; Upper Extremity - blood supply; Vascular Access Devices; Vascular Patency; PTA-PCB+PB; RCAVF; PTA-PB; Paclitaxel-coated balloons; PTA performed with PCB and PB; target lesion restenosis; PCB; radiocephalic arteriovenous fistula; PB; hemodialysis; TLR; HD; PTA performed with conventional PB alone; plain balloon
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2013.12.014

Abstract Purpose To determine whether the use of a paclitaxel-coated balloon (PCB) improves patency in patients undergoing percutaneous transluminal angioplasty (PTA) for recurrent juxtaanastomotic stenosis of radiocephalic arteriovenous fistulas (RCAVFs). Material and Methods This prospective study recruited hemodialysis patients with two short (< 2 cm) and separated inflow RCAVF lesions. After dilation of lesions using a 4-mm plain balloon (PB), half of the lesions were randomly selected for treatment with PTA using PCB (size, 4 mm; length, 2 cm) and PB (size, 5-mm or 6-mm) (group 1), and the other half were treated with PTA using PB alone (group 2). After the index PTA, dysfunction-driven angiography was performed to confirm target lesion restenosis (TLR). TLR and lesion patency were compared in the two groups by χ2 test, t test, and Kaplan-Meier analysis. Results The analysis of 20 lesions in 10 patients revealed that the TLR-free duration in group 1 was significantly longer than the TLR-free duration in group 2 (251.2 d vs 103.2 d; P < .01). The patency rate of the target lesion was significantly higher in group 1 than in group 2 at 6 months (70% vs 0%; P < .01) but not at 12 months (20% vs 0%; P > .05). Conclusions This early study suggests that, for improving short-term patency, PTA with PCB and PB is more effective than PTA with PB alone, warranting further study.