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Echefu G, Shivangi S, Dukkipati R, Schellack J, Kumbala D. Contemporary review of management techniques for cephalic arch stenosis in hemodialysis. Ren Fail 2023; 45:2176166. [PMID: 36748927 PMCID: PMC9930846 DOI: 10.1080/0886022x.2023.2176166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/29/2023] [Indexed: 02/08/2023] Open
Abstract
The type of hemodialysis access and its preservation impact the quality of life and survival of patients undergoing hemodialysis. Vascular access complications are among the top causes of morbidity, hospitalization, and catheter use, with significant economic burden. Poor maturation and stenosis continue to be key impediments to upper arm arteriovenous fistula feasibility. Cephalic arch is a common location for vascular access dysfunction due to its distinctive anatomy, complex valves, and biochemical alterations attributable to renal failure. Understanding cephalic arch stenosis is critical due to its high prevalence and treatment failure. The appropriate management option is highly debatable and mostly dependent on patient characteristics and interventionist's preference. Current options include, percutaneous transluminal balloon angioplasty, stent grafts, bare metal stents, cutting balloon angioplasty, endovascular banding, and surgical procedures. This article discusses the etiologies of cephalic arch stenosis as well as currents trends in management including endovascular and surgical options.
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Affiliation(s)
- Gift Echefu
- Internal Medicine residency program, Baton Rouge General Medical Center, Baton Rouge, LA, USA
| | - Shivangi Shivangi
- Internal Medicine residency program, Baton Rouge General Medical Center, Baton Rouge, LA, USA
| | - Ramanath Dukkipati
- Harbor–University of California Los Angeles Medical Center, Torrance, CA, USA
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Echefu G, Stowe I, Lukan A, Sharma G, Basu-Ray I, Guidry L, Schellack J, Kumbala D. Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies. FRONTIERS IN NEPHROLOGY 2023; 3:1280666. [PMID: 38022724 PMCID: PMC10664753 DOI: 10.3389/fneph.2023.1280666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Abdulkareem Lukan
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Gaurav Sharma
- Department of Nephrology, AIIMS Rishikesh, Rishikesh, India
| | - Indranill Basu-Ray
- Department of Cardiology, AIIMS Rishikesh, Rishikesh, India
- Department of Cardiovascular Disease, Memphis Veterans Affairs Medical Center, Memphis, TN, United States
| | - London Guidry
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Jon Schellack
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Damodar Kumbala
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
- Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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Kitrou P, Katsanos K, Karnabatidis D. Management of Central Venous Stenoses and Occlusions. Cardiovasc Intervent Radiol 2023; 46:1182-1191. [PMID: 37460644 PMCID: PMC10471665 DOI: 10.1007/s00270-023-03461-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/01/2023] [Indexed: 09/02/2023]
Abstract
Symptomatic central venous stenosis and occlusion remains the gordian knot of vascular access. Advances in techniques, like sharp recanalization, allowed for improved success rates in crossing these difficult lesions. There is also increasing evidence of new devices in treating central venous stenosis and, at the same time, improving the time needed between interventions. High-pressure balloons, paclitaxel-coated balloons, bare metal stents and covered stents have been tested with an aim to offer additional treatment options, although obstacles still exist. In the current review, authors describe relevant techniques and options, provide the evidence and evaluate the actual implementation of these devices in this demanding field.
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Affiliation(s)
- Panagiotis Kitrou
- Interventional Radiology, Patras University Hospital, Patras, Greece.
- Medical School, University of Patras, Patras, Greece.
| | - Konstantinos Katsanos
- Interventional Radiology, Patras University Hospital, Patras, Greece
- Medical School, University of Patras, Patras, Greece
| | - Dimitrios Karnabatidis
- Interventional Radiology, Patras University Hospital, Patras, Greece
- Medical School, University of Patras, Patras, Greece
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Kitrou P, Katsanos K, Georgopoulou GA, Karnabatidis D. Drug-Coated Balloons for the Dysfunctional Vascular Access: An Evidence-Based Road Map to Treatment and the Existing Obstacles. Semin Intervent Radiol 2022; 39:56-65. [PMID: 35210734 PMCID: PMC8856785 DOI: 10.1055/s-0042-1742483] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An underlying stenosis within the venous limb of a hemodialysis access circuit is the main etiology for graft and fistula dysfunction as well as other symptoms such as arm, breast, and neck swelling. Treatment options for both peripheral and central venous stenoses include plain old balloon angioplasty, angioplasty with drug-coated balloons, and stenting. This article discusses the current evidence for the use of drug-coated balloon angioplasty in this patient population.
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Affiliation(s)
- Panagiotis Kitrou
- Department of Interventional Radiology, Patras University Hospital, Patras, Greece,Address for correspondence Panagiotis Kitrou, MD Department of Interventional Radiology, Patras University HospitalPatras 26500Greece
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Jaffer O, Gibbs P, Gibson M, Gilbert J, Hanko J, Jeevaratnam P, Jones R, Nicholas J, Ramnarine R, Sivaprakasam R, Steiner K, Tippett R, Wilkins J. A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients. Cardiovasc Intervent Radiol 2021; 44:1736-1746. [PMID: 34231014 DOI: 10.1007/s00270-021-02875-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Stenoses in mature arteriovenous fistulas (AVFs) are common and can negatively impact on the quality of haemodialysis, the longevity of the AVF and lead to debilitating symptoms. Multiple treatment options exist; however, management can vary between different centres. We aimed to establish multidisciplinary consensus on the optimal stepwise application of interventions based on evidence and consensus. METHODS A modified Delphi process was conducted with 13 participants from hospitals across the UK, all of whom have high-volume dialysis access practice. RESULTS The usual intervention to rectify de novo stenoses of mature AVFs is fistuloplasty, although surgery for inflow segment stenoses is also clinically acceptable. Appropriate first-line interventions include plain old balloon angioplasty or high-pressure balloon angioplasty; if these fail during the fistuloplasty, consider upsizing the balloon, prolonged balloon inflation or using alternative interventions, such as cutting or scoring balloons and ultra-high-pressure balloons. Alternative or subsequent interventions vary by anatomical site and may require additional multidisciplinary team input. For a stenoses recurring between 3 and 12 months, it is appropriate to consider interventions used de novo, but with a lower threshold for using drug-coated balloons (DCBs) in all regions and for using stent grafts in all regions but inflow segment. Recurrence after 12 months should be treated as a de novo lesion, with DCBs considered if they have been used successfully during previous interventions. CONCLUSIONS These recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying AVF stenoses and provide unified evidence-based practice guidelines.
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Affiliation(s)
- Ounali Jaffer
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, UK.
| | - Paul Gibbs
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Matthew Gibson
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - James Gilbert
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jennifer Hanko
- Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Robert Jones
- University Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Johann Nicholas
- Royal Shrewsbury Hospital, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Raymond Ramnarine
- Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Rajesh Sivaprakasam
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, UK
| | - Kate Steiner
- Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
| | - Richard Tippett
- Dorset County Hospital, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Jason Wilkins
- King's College Hospital NHS Foundation Trust, London, UK
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Kitrou PM, Steinke T, El Hage R, Ponce P, Lucatelli P, Katsanos K, Spiliopoulos S, Spinelli A, Bisdas T, Stavroulakis K, Jaffer O, Mallios A, Zilahi de Gyurgyokai S, Cancellieri R, Coscas R, Karnabatidis D. Paclitaxel-Coated Balloons for the Treatment of Symptomatic Central Venous Stenosis in Vascular Access: Results From a European, Multicenter, Single-Arm Retrospective Analysis. J Endovasc Ther 2021; 28:442-451. [PMID: 33834905 DOI: 10.1177/15266028211007471] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This was a European, multicenter, investigator-initiated and run, single-arm retrospective analysis to assess the safety and the clinical benefit of the use of paclitaxel-coated balloon (PCB) for the treatment of symptomatic central venous stenosis (CVS). MATERIALS AND METHODS Eleven centers from 7 countries across Europe, submitted 86 cases performed during the period between October 2015 and June 2018. Minimum follow-up was 6 months. Patient baseline demographics and procedural details were collected. Mean age was 62.6 years (SD 15.2 years). Median vascular access age was 3.0 years (IQR 1.2-4.8 years). A total of 55 were arteriovenous fistulas (64%) the rest arteriovenous grafts (31/86, 36%). Vessels treated were 43 subclavian veins, 42 brachiocephalic veins and 1 superior vena cava. Median drug-coated balloon diameter was 10 mm (IQR 8-12 mm). Primary outcome measures were clinically assessed intervention-free period (IFP) of the treated segment at 6 months and procedure-related minor and major complications. Secondary outcome measures included access circuit survival, patient survival, and the investigation of independent factors that influence the IFP. RESULTS IFP was 62.7% at 6 months. Median patient follow-up time was 1.0 year (IQR 0.5-2.2 years). There was 1 minor complication (1/86; 1.2%) and no major complications. Access circuit survival was 87.7% at 6 months. Patient survival was 79.7% at 2 years according to Kaplan-Meier survival analysis. Higher balloon diameters significantly favored IFP [HR 0.71 (0.55-0.92), p=0.006; 5-7 mm group vs 8-12 mm group, p=0.025]. CONCLUSION In this analysis, use of PCBs for the treatment of symptomatic CVS was safe. Efficacy was comparable to previous trials. Increased balloon size had a significant effect on patency rates.
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Affiliation(s)
| | - Tobias Steinke
- Fachzentrum für Gefäßchirurgie, Schön Klinik Düsseldorf SE & Co. KG, Düsseldorf, Germany
| | - Rami El Hage
- Vasular Surgery, Paris Saint Joseph Hospital, Paris, France
| | - Pedro Ponce
- Fresenius Medical Care Portugal/Nephrocare, Lisbon, Portugal
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome, Italy
| | | | - Stavros Spiliopoulos
- Second Department of Radiology, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Alessio Spinelli
- U.O.S.D. of Interventional Radiology, Hospital "S. Eugenio" Rome, ASL Roma, Italy
| | - Theodosios Bisdas
- Third Clinic of Vascular Surgery, Athens Medical Center, Athens, Greece
| | - Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Ounali Jaffer
- Department of Diagnostic and International Radiology, Barts NHS Trust, Royal London Hospital, London, UK
| | | | - Simone Zilahi de Gyurgyokai
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome, Italy
| | - Roberto Cancellieri
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome, Italy
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France
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Karnabatidis D, Kitrou PM, Ponce P, Chong TT, Pietura R, Pegis JD, Ko PJ, Lin CH. A Multicenter Global Registry of Paclitaxel Drug-Coated Balloon in Dysfunctional Arteriovenous Fistulae and Grafts: 6-Month Results. J Vasc Interv Radiol 2021; 32:360-368.e2. [PMID: 33495064 DOI: 10.1016/j.jvir.2020.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the safety and clinical benefit of the Lutonix drug-coated balloon (DCB) catheter for the treatment of dysfunctional arteriovenous fistulae (AVF) and grafts (AVG) in a heterogenous real-world population. MATERIALS AND METHODS This multicenter, prospective study enrolled 320 subjects from 12 countries in 25 sites across Europe and Asia. A total of 392 lesions were treated with the Lutonix 035 DCB catheter. Lesions were de novo and restenotic, located in every part of the circuit from the cannulation zone to central venous outflow. In-stent restenotic lesions also were treated. The primary safety endpoint was freedom from serious adverse events involving the access circuit through 30 days. The primary effectiveness endpoint was target lesion primary patency (TLPP) through 6 months. Secondary endpoints included access circuit primary patency (ACPP) at 6 months and the investigation of factors that would independently influence the primary endpoints. RESULTS The primary safety endpoint was 95.5%, while TLPP was 73.9% at 6 months, per Kaplan-Meier survival analysis. ACPP was 71% at 6 months. TLPP for stenosis of AVFs was 78.1%. Subgroup analysis showed significantly improved TLPP when DCB was dilated for ≥120 seconds (P = .007). TLPP was significantly better when predilation occurred compared with cases where only DCB angioplasty was performed (77% vs 48.6%, P = .0005). CONCLUSIONS The Lutonix AV Global Registry confirms that the Lutonix DCB is a safe and effective treatment option in real-world patients with dysfunctional AVF or AVG. Procedural details had a significant role in TLPP. No significant difference in TLPP was observed among different treatment areas.
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Affiliation(s)
| | - Panagiotis M Kitrou
- Interventional Radiology Department, Patras University Hospital, Patras, Greece.
| | - Pedro Ponce
- Fresenius Medical Care Portugal/NephroCare, Lisbon, Portugal
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
| | | | | | - Po-Jen Ko
- Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia Hsun Lin
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Yazar O, Provoost A, Broughton A, Ghijselings L, Leclef Y, Van Calster K, Reginster F, Fourneau I. Paclitaxel drug-coated balloon angioplasty for the treatment of failing arteriovenous fistulas: a single-center experience. Acta Chir Belg 2020; 120:85-91. [PMID: 30633638 DOI: 10.1080/00015458.2018.1561796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: To report our experience of angioplasty with Lutonix (Bard Peripheral Vascular, Inc., Tempe, AZ) drug-coated balloon (DCB) for the treatment of failing arteriovenous fistulas (AVF).Materials and methods: Retrospective, single-center analysis consisting of 14 patients treated with Lutonix paclitaxel DCBs in the period from July 2015 through April 2017. We analyzed technical success, clinical success, primary patency of the target lesion, primary patency of the dialysis circuit, and the rate of complications. Regular follow-up of AVF patency was realized by clinical examination and duplex ultrasonography. The Kaplan-Meier survival method was applied to determine the cumulative primary patency of the target lesion and the dialysis circuit.Results: Technical success was 100% and clinical success 92.9%. There were no major or minor complications. Cumulative target lesion primary patency after DCB was 69.2% at 6 months and 31.6% at 12 months. Cumulative vascular circuit primary patency was 61.5% at 6 months and 31.6% at 12 months.Conclusion: Compared to results reported in literature with plain old balloon angioplasty (POBA), Lutonix paclitaxel DCB angioplasty proved a short-term patency benefit in treatment of dialysis AVF stenosis.
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Affiliation(s)
- O. Yazar
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - A. Provoost
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - A. Broughton
- Department of Nephrology, Europe Hospitals Brussels, Brussels, Belgium
| | - L. Ghijselings
- Department of Radiology, Europe Hospitals Brussels, Brussels, Belgium
| | - Y. Leclef
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - K. Van Calster
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - F. Reginster
- Department of Nephrology, Europe Hospitals Brussels, Brussels, Belgium
| | - I. Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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9
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Central venous occlusion in hemodialysis access: Comparison between percutaneous transluminal angioplasty alone and nitinol or stainless-steel stent placement. Diagn Interv Imaging 2019; 100:485-492. [DOI: 10.1016/j.diii.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
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10
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Phang CC, Tan RY, Pang SC, Tan CW, Teh SP, Cheng R, Kho YX, Chong TT, Gogna A, Foo WY, Tan CS. Paclitaxel‐coated balloon in the treatment of recurrent dysfunctional arteriovenous access, real‐world experience and longitudinal follow up. Nephrology (Carlton) 2019; 24:1290-1295. [DOI: 10.1111/nep.13591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Chee Chin Phang
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Ru Yu Tan
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Suh Chien Pang
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Chee Wooi Tan
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Swee Ping Teh
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | | | - Yu Xuan Kho
- NUS Yong Loo Lin School of Medicine Singapore Singapore
| | - Tze Tec Chong
- Department of Vascular SurgerySingapore General Hospital Singapore Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional RadiologySingapore General Hospital Singapore Singapore
| | - Wai Yin Foo
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
| | - Chieh Suai Tan
- Department of Renal MedicineSingapore General Hospital Singapore Singapore
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11
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Use of Drug-Coated Balloons in Dysfunctional Arteriovenous Dialysis Access Treatment: The Effect of Consecutive Treatments on Lesion Patency. J Vasc Interv Radiol 2019; 30:212-216. [DOI: 10.1016/j.jvir.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 12/27/2022] Open
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Kitrou P, Papasotiriou M, Katsanos K, Karnabatidis D, Goumenos DS, Papachristou E. Recent developments in endovascular interventions to sustain vascular access patency in haemodialysis patients. Nephrol Dial Transplant 2018; 34:1994-2001. [DOI: 10.1093/ndt/gfy354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/12/2018] [Indexed: 12/22/2022] Open
Abstract
Abstract
There is amassed evidence regarding the use of endovascular procedures for the treatment of vascular access stenosis and thrombosis. A review was conducted based on available randomized trials, cohort studies and retrospective analyses published after 2000 on endovascular treatment of dysfunctional and thrombosed vascular access, with an aim to illustrate the available device and procedural options. The use of paclitaxel-coated balloons, cutting balloons and covered stents is described in the field of vascular access stenosis. The broad spectrum of available devices and endovascular declotting procedures ranging from thrombolysis to thrombectomy is also discussed. Overall, in this review we demonstrate the increasing role of endovascular procedures in vascular access treatment and the improved patency outcomes provided by the implementation of novel endovascular devices. Moreover, the improvement of post-intervention primary patency rates after endovascular declotting procedures and the shift to more thrombectomy-dependent procedures over time is also highlighted. In conclusion, endovascular treatment of dialysis access stenosis and thrombosis has an established role, owing to the implementation of sophisticated devices, allowing, when needed, the simultaneous treatment of thrombosis and the underlying stenosis.
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Affiliation(s)
- Panagiotis Kitrou
- Interventional Radiology Department, Patras University Hospital, Patras, Greece
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13
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Spiliopoulos S, Kitrou PM, Brountzos EN. Revisiting endovascular treatment in below-the-knee disease. Are drug-eluting stents the best option? World J Cardiol 2018; 10:196-200. [PMID: 30510636 PMCID: PMC6259030 DOI: 10.4330/wjc.v10.i11.196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/19/2018] [Accepted: 10/12/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with below-the-knee arterial disease are primarily individuals suffering from critical limb ischemia (CLI), while a large percentage of these patients are also suffering from diabetes or chronic renal failure or both. Available data from randomized controlled trials and their meta-analysis demonstrated that the use of infrapopliteal drug-eluting stents (DES), in short- to medium- length lesions, obtains significantly better results compared to plain balloon angioplasty and bare metal stenting with regards to vascular restenosis, target lesion revascularization, wound healing and amputations. Nonetheless, the use of this technology in every-day clinical practice remains limited mainly due to concerns regarding the deployment of a permanent metallic scaffold and the possibility of valid future therapeutic perspectives. However, in the majority of the cases, these concerns are not scientifically justified. Large-scale, multicenter randomized controlled trials, investigating a significantly larger number of patients than those already published, would provide more solid evidence and consolidate the use of infrapopliteal DES in CLI patients. Moreover, there is still little evidence on whether this technology can be as effective for longer below-the-knee lesions, where a considerable number of DES is required. The development and investigation of new, longer balloon-expanding or perhaps self-expanding DES could be the answer to this problem.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Radiology Department, Interventional Radiology Unit, University of Athens, Attikon University General Hospital, Athens 12461, Greece
| | - Panagiotis M Kitrou
- Department of Interventional Radiology, Patras University Hospital, Patras 26500, Greece
| | - Elias N Brountzos
- 2nd Radiology Department, Interventional Radiology Unit, University of Athens, Attikon University General Hospital, Athens 12461, Greece
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14
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Irani FG, Teo TKB, Tay KH, Yin WH, Win HH, Gogna A, Patel A, Too CW, Chan SXJM, Lo RHG, Toh LHW, Chng SP, Choong HL, Tan BS. Hemodialysis Arteriovenous Fistula and Graft Stenoses: Randomized Trial Comparing Drug-eluting Balloon Angioplasty with Conventional Angioplasty. Radiology 2018; 289:238-247. [DOI: 10.1148/radiol.2018170806] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farah Gillan Irani
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Terence Kiat Beng Teo
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Kiang Hiong Tay
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Win Htet Yin
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Hlaing Hlaing Win
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Apoorva Gogna
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Ankur Patel
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Chow Wei Too
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Shaun Xavier Ju Min Chan
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Richard Hoau Gong Lo
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Luke Han Wei Toh
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Siew Ping Chng
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Hui Lin Choong
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
| | - Bien Soo Tan
- From the Departments of Vascular and Interventional Radiology (F.G.I., K.H.T., W.H.Y., H.H.W., A.G., A.P., C.W.T., S.X.J.M.C., R.H.G.L., L.H.W.T., B.S.T.), Vascular Surgery (S.P.C.), and Renal Medicine (H.L.C.), Block 2 Level 1, Singapore General Hospital, Outram Rd, Singapore 169608; and Department of Radiology, Mount Elizabeth Hospital, Singapore (T.K.B.T.)
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Patanè D, Failla G, Coniglio G, Russo G, Morale W, Seminara G, Calcara G, Bisceglie P, Malfa P. Treatment of juxta-anastomotic stenoses for failing distal radiocephalic arteriovenous fistulas: Drug-coated balloons versus angioplasty. J Vasc Access 2018; 20:209-216. [DOI: 10.1177/1129729818793102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim of our study is to report the results of two types (type A, type B) paclitaxel drug-coated balloon compared with standard percutaneous transluminal angioplasty in the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic hemodialysis arteriovenous fistulas. Two groups of 26 and 44 patients treated with two different drug-coated balloon are compared with a control group of 86 treated with standard percutaneous transluminal angioplasty. A color Doppler ultrasound was performed to evaluate stenosis and for treatment planning. We assess primary patency, defined as the absence of dysfunction of the arteriovenous fistulas, patent lesion or residual stenosis < 30% and no need for further reintervention of target lesion. Primary patency and secondary patency are evaluated after 12 months with color Doppler ultrasound for the whole arteriovenous fistulas, defined as absolute (absolute primary patency, absolute secondary patency) and target lesion. Postprocedural technical and clinical success was 100%. After 12 months, absolute primary patency is 81.8% for type A, 84.1% type B, and 54.7% for standard percutaneous transluminal angioplasty; target lesion primary patency is 92% type A, 86.4% type B, and 62.8% standard percutaneous transluminal angioplasty; absolute secondary patency is 95.4% type A, 95.5% type B, and 80.7% standard percutaneous transluminal angioplasty; target lesion secondary patency is 100% type A, 97.7% type B, and 80.7% standard percutaneous transluminal angioplasty. All the patients treated with drug-coated balloon (type A + type B) have an absolute primary patency of 83.3%, a target lesion primary patency of 87.9%, an absolute secondary patency of 95.5%, and a target lesion secondary patency of 98.4%. Our study confirms that the use of drug-coated balloon, indiscriminately among different brands, improves primary patency with statistically significant difference in comparison with standard percutaneous transluminal angioplasty and decreases reintervention of target lesion in juxta-anastomotic stenoses of failing distal arteriovenous fistulas maintaining the radiocephalic fistula as long as possible.
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Affiliation(s)
- Domenico Patanè
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giovanni Failla
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giovanni Coniglio
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera Papardo, Messina, Italy
| | - Giorgio Russo
- IBFM CNR, Cefalù 90015(PA) and UOS Fisica Sanitaria, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Walter Morale
- Department of Nefrology e Dialisys, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giuseppe Seminara
- Department of Nefrology e Dialisys, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giacomo Calcara
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Paola Bisceglie
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Pierantonio Malfa
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
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16
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Sakata KK, Nelson DR, Mullon JJ, Midthun DE, Edell ES, Kern RM. Paclitaxel-coated balloon dilation for central airway obstruction. Respir Med Case Rep 2018; 24:129-132. [PMID: 29988293 PMCID: PMC6010649 DOI: 10.1016/j.rmcr.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Central airway obstruction (CAO) often requires repeated interventional procedures which offer variable efficacy, a time-limited effect, and have inherent limitations. Paclitaxel has been used to prevent restenosis in blood vessels. The literature describing the use of paclitaxel to prevent recurrent airway stenosis is limited. We sought to describe our experience using a paclitaxel-coated balloon (PCB) for CAO. Material and methods We performed a retrospective review of all patients who underwent PCB airway dilation. We collected: basic demographics, details of the CAO, details of the bronchoscopes used, PCB size, PCB dilation pressure, duration of PCB inflation, concurrent non-PCB interventions, estimated pre- and post-PCB CAO luminal diameter, follow up bronchoscopy date and luminal diameter, and spirometry results. Results PCB dilation was performed in 10 cases on 5 patients. Eight PCB dilations were performed for CAO related to distal airway stent stenosis. Concurrent non-PCB interventions were performed with 6 PCB dilations. Nine cases documented improvements and 1 was unchanged immediately post-PCB dilation. Median luminal diameter pre-PCB dilation was 2 mm. Immediately post-PCB dilation, the median change in luminal diameter was 2 mm. Follow up bronchoscopy information was available for 9 cases. For these 9 cases, luminal diameter was unchanged in 5 and worse in 4 when compared to immediate post-PCB dilation. Conclusion PCB dilation in benign CAO produced a modest effect in this cohort of challenging airways. Larger prospective studies are needed to assess how a PCB would perform when compared to a non-drug coated balloon.
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Affiliation(s)
- Kenneth K. Sakata
- Corresponding author. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Kitrou PM, Katsanos K, Papadimatos P, Spiliopoulos S, Karnabatidis D. A survival guide for endovascular declotting in dialysis access: procedures, devices, and a statistical analysis of 3,000 cases. Expert Rev Med Devices 2018; 15:283-291. [PMID: 29546804 DOI: 10.1080/17434440.2018.1454311] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Thrombosis is the most important access-related complication. Several declotting procedures have been suggested falling mainly into two categories; thrombolysis-dependent and thrombectomy-dependent. AREAS COVERED Seventeen studies after 2001 have been published on percutaneous treatment of thrombosed vascular access. Authors performed a systematic review of these studies together with a parametric meta-analysis of data available investigating clinical success, postintervention assisted primary patency (PAPP) and independent factors that could influence outcome measures. EXPERT COMMENTARY A shift to thrombectomy-dependent procedures is observed with a view to diminishing complications from the use of thrombolytic agents. Arteriovenous fistulas provide significantly better PAPP, while newer studies show improved, non-significant results compared with older ones. The role of improvement of devices for subsequent angioplasty is of equal importance, if not more, for improved declotting results.
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Affiliation(s)
- Panagiotis M Kitrou
- a Department of Interventional Radiology , Patras University Hospital, School of Medicine , Rion , Greece
| | - Konstantinos Katsanos
- a Department of Interventional Radiology , Patras University Hospital, School of Medicine , Rion , Greece
- b Department of Interventional Radiology , Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners , London , UK
| | - Panagiotis Papadimatos
- a Department of Interventional Radiology , Patras University Hospital, School of Medicine , Rion , Greece
| | - Stavros Spiliopoulos
- c 2nd Department of Radiology , Interventional Radiology Unit, ATTIKO Athens University Hospital , Athens , Greece
| | - Dimitris Karnabatidis
- a Department of Interventional Radiology , Patras University Hospital, School of Medicine , Rion , Greece
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Kitrou PM, Papadimatos P, Spiliopoulos S, Christeas N, Katsanos K, Karnabatidis D. Lysis-Assisted Balloon (LAB) Thrombectomy. A Declotting Technique for the Treatment of Thrombosed Arteriovenous Dialysis Grafts. 5-Year Experience of 241 Endovascular Procedures. Cardiovasc Intervent Radiol 2018; 41:245-252. [PMID: 29075875 DOI: 10.1007/s00270-017-1813-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/09/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND This is a retrospective single-center analysis investigating the results of a percutaneous lysis-assisted balloon (LAB) thrombectomy procedure for the treatment of thrombosed arteriovenous dialysis grafts (AVGs). MATERIALS AND METHODS Within 5 years (January 2012-December 2016), 291 declotting procedures were performed for the treatment of thrombosed dialysis arteriovenous fistulas or grafts. Data were available for 129 patients (75 men, 58.1%) with an AVG, undergoing 241 procedures [1.87 procedures/patient (1-10)]. Procedure includes initial lysis with 5 mg recombinant tissue plasminogen activator followed by thrombectomy with a high-pressure balloon for thrombus maceration using "facing sheaths" technique. 61 patients had ≥ 2 declotting procedures. In 80 cases (80/241; 33.2%), a stent graft (SG) was used for treatment of persistent stenosis. Main primary outcome measures were clinical success and postintervention assisted primary patency (PAPP). Secondary outcome measures included procedural complications and investigation of independent factors that could influence circuit survival. RESULTS Median PAPP was 434 days according to Kaplan-Meier survival analysis. Clinical success was 96.26%. In six cases (6/241, 2.49%) declotting failed and a catheter was placed. There were 16 minor (16/241, 6.64%) and no major complications. There was no significant difference in circuit survival regardless of SG use (No SG 406 days vs. SG 349 days; p = 0.24). There was a significant difference in favor of the second declotting compared to the first in 61 patients (first: 162 days vs. second: 447 days; p < 0.0001). CONCLUSION LAB thrombectomy resulted in high-circuit survival rates with increased technical success and minimum complications without the use of thrombectomy devices.
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Affiliation(s)
- Panagiotis M Kitrou
- Interventional Radiology Department, Patras University Hospital, Patras, Greece.
| | | | - Stavros Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Division, Attikon University Hospital, Athens, Greece
| | - Nicolaos Christeas
- Interventional Radiology Department, Patras University Hospital, Patras, Greece
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Abstract
OBJECTIVE To present our experience of balloon-assisted maturation with drug-eluting balloon dilation in patients with recurrent failing arteriovenous fistulae. CASE SERIES Three patients (all males, mean age 71 years) with a complex history of failed attempts at native fistula creation underwent surgical creation of arteriovenous fistulae. Two patients had a two-stage brachio-brachial fistula and 1 had a brachio-cephalic fistula that also required subsequent elevation. After a few weeks of preserved patency with a thrill detected clinically, all patients had a gradual deterioration of flow manifested with loss of thrill and multiple severely stenotic lesions of neo-intimal hyperplasia seen on duplex ultrasound. All 3 non-maturing native arteriovenous fistulae had 1 or more angioplasties with regular balloons that were initially successful; however, they rapidly deteriorated with a loss of thrill and a recurrence of multiple stenosis. Drug-eluting balloon dilation was used subsequently as a last resort to save these failing fistulae. All procedures were successful with the preservation of patency and adequate fistula flow (>600 mL/min) during the follow-up period (4-8 months, mean 6 months), and all patients received successful dialysis with 2-needle cannulation of their fistulae. There were no adverse events during the study period. CONCLUSIONS Drug-eluting balloon angioplasty was to salvage nonmaturing fistulae with durable results in complex patients where conventional treatment had previously failed. Drug-eluting balloons may provide a useful treatment option for patients prone to multiple access failures due accelerated neo-intimal hyperplasia.
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Kitrou PM, Papadimatos P, Spiliopoulos S, Katsanos K, Christeas N, Brountzos E, Karnabatidis D. Paclitaxel-Coated Balloons for the Treatment of Symptomatic Central Venous Stenosis in Dialysis Access: Results from a Randomized Controlled Trial. J Vasc Interv Radiol 2017; 28:811-817. [PMID: 28434662 DOI: 10.1016/j.jvir.2017.03.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/04/2017] [Accepted: 03/10/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To compare the clinically-assessed intervention-free period (IFP) of paclitaxel-coated balloon (PCB) vs conventional balloon angioplasty (CBA) for the treatment of symptomatic central venous stenosis (CVS) in dialysis access. MATERIALS AND METHODS Within 20 months, 40 dialysis patients (19/40 arteriovenous fistulae [AVFs] and 21/40 arteriovenous grafts [AVGs]) were randomized to undergo angioplasty either with a PCB (PCB group, n = 20; 14/20 male; age: 56.7) or CBA (CBA group, n = 20; 15/20 male; age: 57). There were 15/20 restenotic lesions in PCB group and 12/20 in CBA group. In 25/40 cases, patients had an ipslateral catheter insertion in the past. Primary endpoint was clinically-assessed intervention-free period (IFP) of the treated segment at 6 months, while secondary endpoints included complication rates during follow-up period and identification of factors influencing IFP. RESULTS Median IFP was significantly better in PCB group (PCB group: 179 days, vs CBA group: 124.5 days, P = .026). Mean follow-up period was 180 days (range, 5-479). There was no significant difference between AVGs and AVFs (P = .17), treatment of de novo vs restenotic lesions (P = .33), or prior presence of catheter insertion (P = .21). No complications were observed. In restenotic lesions in PCB group, longitudinal comparison between treatments also showed a significant difference in favor of PCB treatment (median IFP in PCB* group 177 vs 91 days in CBA* group; P = .01). CONCLUSIONS In this prospective study, PCB had significantly better results compared with CBA for the treatment of symptomatic central venous stenosis in dialysis access. Retrospective longitudinal comparison of treatments in the same patients also showed a significant difference in favor of PCBs.
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Affiliation(s)
- Panagiotis M Kitrou
- Interventional Radiology Department, Patras University Hospital, Patras, Greece.
| | | | - Stavros Spiliopoulos
- Second Department of Radiology, Division of Interventional Radiology, Attikon University General Hospital, Athens, Greece
| | | | - Nicolaos Christeas
- Interventional Radiology Department, Patras University Hospital, Patras, Greece
| | - Elias Brountzos
- Second Department of Radiology, Division of Interventional Radiology, Attikon University General Hospital, Athens, Greece
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