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Pinelo A, Almeida P, Loureiro L, Rego D, Teixeira S, Mendes D, Teles P, Sousa C, de Matos N. Use of a Paclitaxel Drug-Eluting Stent for the Treatment of Hemodialysis Access Outflow Stenosis. J Vasc Interv Radiol 2024; 35:384-389. [PMID: 37995865 DOI: 10.1016/j.jvir.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To evaluate the outcomes and durability of drug-eluting stents (DESs) for the treatment of hemodialysis access outflow stenosis. MATERIAL AND METHODS A single-center retrospective analysis was conducted of all patients with hemodialysis vascular access outflow stenosis treated with a paclitaxel-coated DES (Eluvia; Boston Scientific, Marlborough, Massachusetts) between January 2020 and July 2022. A total of 34 DESs were implanted to treat outflow stenosis in 32 patients. Primary target lesion patency after stent deployment was the main outcome. Comparison between the time interval free from target lesion reintervention (TLR) after previous plain balloon angioplasty (PBA) and that after stent deployment for the same target lesion was considered a secondary outcome. RESULTS The primary patency at 6, 12, and 18 months was 63.1%, 47.6%, and 41.7%, respectively. The secondary patency rate was 100% at 18 months. The median time interval free from TLR increased from 4.1 to 11.9 months (P < .001). No adverse events were observed during the median follow-up period of 387 days. CONCLUSIONS The patency rates after use of DES for hemodialysis access outflow stenosis were comparable with results for drug-coated balloons and stent grafts, addressing recoil and minimizing the risk of jailing by a covered stent.
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Affiliation(s)
- Andreia Pinelo
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Paulo Almeida
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Loureiro
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Duarte Rego
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sérgio Teixeira
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Daniel Mendes
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo Teles
- Scientific Department of Mathematics and Information Systems, School of Economics and LIAAD-INESC Porto LA, Porto University, Porto, Portugal
| | - Clemente Sousa
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal; Nursing School Porto, Porto, Portugal
| | - Norton de Matos
- Grupo de Estudos Vasculares, Vascular Access Center, Porto, Portugal
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2
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Shazly T, Torres WM, Secemsky EA, Chitalia VC, Jaffer FA, Kolachalama VB. Understudied factors in drug-coated balloon design and evaluation: A biophysical perspective. Bioeng Transl Med 2023; 8:e10370. [PMID: 36684110 PMCID: PMC9842065 DOI: 10.1002/btm2.10370] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/28/2022] [Accepted: 06/12/2022] [Indexed: 01/25/2023] Open
Abstract
Drug-coated balloon (DCB) percutaneous interventional therapy allows for durable reopening of the narrowed lumen via physical tissue expansion and local anti-restenosis drug delivery, providing an alternative to traditional uncoated balloons or a permanent indwelling implant such as a conventional metallic drug-eluting stent. While DCB-based treatment of peripheral arterial disease (PAD) has been incorporated into clinical guidelines, DCB use has been recently curtailed due to reports that showed evidence of increased mortality risk in patients treated with paclitaxel (PTX)-coated balloons. Given the United States Food and Drug Administration's 2019 consequent warning regarding PTX-eluting DCBs and the subsequent marked reduction in clinical DCB use, there is now a critical need to better understand the compositional and mechanical factors underlying DCB efficacy and safety. Most work to date on DCB refinement has focused on designing both the enabling balloon catheter and alternate coatings composed of various drugs and excipients, followed by device evaluation in preclinical and clinical studies. We contend that improvement in DCB performance will require a better understanding of the biophysical factors operative during and following balloon deployment, and moreover that the elaboration and demonstrated control of these factors are needed to address current concerns with DCB use. This article provides a perspective on the biophysical interactions that govern DCB performance and offers new design strategies for the development of next-generation DCB devices.
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Affiliation(s)
- Tarek Shazly
- College of Engineering & ComputingUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - William M. Torres
- College of Engineering & ComputingUniversity of South CarolinaColumbiaSouth CarolinaUSA
- Exponent Inc.PhiladelphiaPennsylvaniaUSA
| | - Eric A. Secemsky
- Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Vipul C. Chitalia
- Department of Medicine, Boston University School of MedicineBoston Veterans Affairs Healthcare SystemBostonMassachusettsUSA
| | - Farouc A. Jaffer
- Cardiovascular Research Center and Cardiology DivisionMassachusetts General HospitalBostonMassachusettsUSA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University School of Medicine; Department of Computer Science and Faculty of Computing & Data SciencesBoston UniversityBostonMassachusettsUSA
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Coscas R, Petrica N, Massy Z, Jayet J, De Launay J. Readmissions Following Arteriovenous Access Creation for Haemodialysis in a French National Database. Eur J Vasc Endovasc Surg 2022; 64:703-710. [PMID: 35988860 DOI: 10.1016/j.ejvs.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE There is a lack of large real world data on arteriovenous (AV) access results. This study aimed to describe the required hospital care during the first year following creation of AV access. METHODS Data from all adult patients who underwent creation of AV access performed in 2017 in a public or private facility were collected through the French national hospitalisation database. Patients were classified into two groups ("de novo" and "secondary") according to their history of prior AV access creation. The primary outcome was the proportion of patients with at least one hospital readmission related to the AV access recorded during the first 12 post-operative months. RESULTS In 2017, 10 476 adult patients underwent AV access creation in France, including 8 690 (83%) de novo creations. An AV fistula was created for 92% of the patients (95% de novo vs. 78% secondary; p < .001). During the first 12 post-operative months, 6 591 (63%) patients recorded at least one related readmission (68% secondary vs. 62% de novo; p < .001). A total of 5 557 (53%) recorded a readmission for surgical/interventional procedure and 2 852 (27%) were observed with a readmission for medical complications. The mean (± standard deviation) number of related readmissions at 12 months was 1.4 ± 1.6 per patient (1.7 ± 1.9 secondary vs. 1.3 ± 1.5 de novo; p < .001). Patients with an AV graft were more frequently readmitted than those with an AV fistula (1.8 ± 2 vs. 1.3 ± 1.5 readmission; p < .001). CONCLUSION This study highlights the high frequency of readmissions during the first 12 months following creation of AV access, particularly in patients who had already undergone creation of a previous AV access or had an AV graft implanted. Further research should focus on tailoring AV access strategies to improve patient quality of life and decrease the healthcare cost burden.
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Affiliation(s)
- Raphael Coscas
- Department of Vascular Surgery, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France.
| | | | - Ziad Massy
- Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France; Department of Nephrology, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France
| | - Jérôme De Launay
- Becton, Dickinson and Company - BD Interventional, Health Economics Department, Voisins-le-Bretonneux, France
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4
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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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5
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Lawson JH, Niklason LE, Roy-Chaudhury P. Challenges and novel therapies for vascular access in haemodialysis. Nat Rev Nephrol 2020; 16:586-602. [PMID: 32839580 PMCID: PMC8108319 DOI: 10.1038/s41581-020-0333-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
Advances in standards of care have extended the life expectancy of patients with kidney failure. However, options for chronic vascular access for haemodialysis - an essential part of kidney replacement therapy - have remained unchanged for decades. The high morbidity and mortality associated with current vascular access complications highlights an unmet clinical need for novel techniques in vascular access and is driving innovation in vascular access care. The development of devices, biological approaches and novel access techniques has led to new approaches to controlling fistula geometry and manipulating the underlying cellular and molecular pathways of the vascular endothelium, and influencing fistula maturation and formation through the use of external mechanical methods. Innovations in arteriovenous graft materials range from small modifications to the graft lumen to the creation of completely novel bioengineered grafts. Steps have even been taken to create new devices for the treatment of patients with central vein stenosis. However, these emerging therapies face difficult hurdles, and truly creative approaches to vascular access need resources that include well-designed clinical trials, frequent interaction with regulators, interventionalist education and sufficient funding. In addition, the heterogeneity of patients with kidney failure suggests it is unlikely that a 'one-size-fits-all' approach for effective vascular access will be feasible in the current environment.
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Affiliation(s)
- Jeffrey H Lawson
- Department of Surgery, Duke University, Durham, NC, USA.
- Humacyte, Inc., Durham, NC, USA.
| | - Laura E Niklason
- Humacyte, Inc., Durham, NC, USA
- School of Engineering & Applied Science, Yale University, New Haven, CT, USA
| | - Prabir Roy-Chaudhury
- University of North Carolina Kidney Center, Chapel Hill, NC, USA
- WG (Bill) Hefner VA Medical Center, Salisbury, NC, USA
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6
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Kim JW, Kim JH, Byun SS, Kang JM, Shin JH. Paclitaxel-Coated Balloon versus Plain Balloon Angioplasty for Dysfunctional Autogenous Radiocephalic Arteriovenous Fistulas: A Prospective Randomized Controlled Trial. Korean J Radiol 2020; 21:1239-1247. [PMID: 32729275 PMCID: PMC7462765 DOI: 10.3348/kjr.2020.0067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Objective To report the mid-term results of a single-center randomized controlled trial comparing drug-coated balloon angioplasty (DBA) and plain balloon angioplasty (PBA) for the treatment of dysfunctional radiocephalic arteriovenous fistulas (RCAVFs). Materials and Methods In this prospective study, 39 patients (mean age, 62.2 years; 21 males, 18 females) with RCAVFs failing due to juxta-anastomotic stenosis were randomly assigned to undergo either both DBA and PBA (n = 20, DBA group) or PBA alone (n = 19, PBA group) between June 2016 and June 2018. Primary endpoints were technical and clinical success and target lesion primary patency (TLPP); secondary outcomes were target lesion secondary patency (TLSP) and complication rates. Statistical analysis was performed using the Kaplan-Meier product limit estimator. Results Demographic data and baseline clinical characteristics were comparable between the groups. Technical and clinical success rates were 100% in both groups. There was no significant difference between the groups in the mean duration of TLPP (DBA group: 26.7 ± 3.6 months; PBA group: 27.0 ± 3.8 months; p = 0.902) and TLSP (DBA group: 37.3 ± 2.6 months; PBA group: 40.4 ± 1.5 months; p = 0.585). No procedural or post-procedural complications were identified. Conclusion Paclitaxel-coated balloon use did not significantly improve TLPP or TLSP in the treatment of juxta-anastomotic stenosis of dysfunctional RCAVFs.
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Affiliation(s)
- Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
| | - Sung Su Byun
- Health Promotion Center, Inha University Hospital, Incheon, Korea
| | - Jin Mo Kang
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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7
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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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8
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Dinh K, Thomas SD, Cho T, Swinnen J, Crowe P, Varcoe RL. Use of Paclitaxel Eluting Stents in Arteriovenous Fistulas: A Pilot Study. Vasc Specialist Int 2019; 35:225-231. [PMID: 31915667 PMCID: PMC6941774 DOI: 10.5758/vsi.2019.35.4.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose We report short-term patency outcomes of a proof of concept study conducted to determine the efficacy of drug-eluting stent (DES) for the treatment of arteriovenous fistula (AVF) stenosis in hemodialysis patients. Materials and Methods This is a single-center, retrospective observational study involving 10 patients with AVF dysfunction treated with DESs between January 2017 and December 2017. The primary outcome was AVF patency confirmed by sonographic and clinical assessment at 1 month and 6 to 9 months after treatment. Results A total of 12 DESs were deployed in 10 patients with dysfunctional AVF (radiocephalic: 7, brachiocephalic: 3). During the early follow up (mean: 28.6 days), primary access circuit and DES patency was 100%, with an average volume flow rate of 886.4 mL/min. Nine patients were available for short-term follow up (mean: 202.4 days; 1 unrelated death), with a mean volume flow rate of 1,048.9 mL/min. The primary DES patency was 7/9 (77.8%), and 3 patients required angioplasty at other parts of the circuit (primary access circuit patency: 4/9 [44.4%]). The assisted primary access circuit patency was 77.8%. In 2 patients, the ultrasound revealed that the DESs were thrombosed without any antecedent stenosis; they were salvaged with angioplasty. Both patients previously underwent 2 DESs implanted and recently stopped dual antiplatelet therapy. B-mode sonographic assessment at all timepoints showed minimal intimal ingrowth on the stent struts. Conclusion This study demonstrates acceptable short-term patency for DESs in the treatment of AVF stenosis. Dual antiplatelet therapy is probably mandatory in the short term.
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Affiliation(s)
- Krystal Dinh
- Department of Surgery, Prince of Wales Hospital, Australia.,Department of Vascular Surgery, Westmead Hospital, Australia
| | - Shannon D Thomas
- Department of Surgery, Prince of Wales Hospital, Australia.,Faculty of Medicine, University of New South Wales, Australia.,The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| | - Tae Cho
- Department of Vascular Surgery, Westmead Hospital, Australia
| | - John Swinnen
- Department of Vascular Surgery, Westmead Hospital, Australia
| | - Phillip Crowe
- Faculty of Medicine, University of New South Wales, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Australia.,Faculty of Medicine, University of New South Wales, Australia.,The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
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9
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Haave TR, Manstad-Hulaas F, Brekken R. Treatment of restenosis in radiocephalic arteriovenous hemodialysis fistulas: percutaneous transluminal angioplasty or drug-coated balloon. Acta Radiol 2019; 60:1584-1589. [PMID: 30897933 DOI: 10.1177/0284185119838173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tina R Haave
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frode Manstad-Hulaas
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
- Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway
| | - Reidar Brekken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway
- Department of Health Research - Medical Technology, SINTEF, Trondheim, Norway
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10
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Kavan J, Kudlicka J, Malik J, Chytilova E, Lambert L, Slavikova M, Matras P, Burgetova A. Treatment of failing arterio-venous dialysis graft by angioplasty, stent, and stent graft: Two-years analysis of patency rates and cost-effectiveness. Exp Ther Med 2019; 18:4144-4150. [PMID: 31641387 DOI: 10.3892/etm.2019.8050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/02/2019] [Indexed: 12/21/2022] Open
Abstract
The objective of this prospective randomized single-center study was to compare primary and secondary patency rates, number of percutaneous transluminal angioplasty (PTA) interventions and cost-effectiveness among PTA, deployment of a stent, or a stent graft in the treatment of failing arteriovenous dialysis grafts (AVG) due to restenosis in the venous anastomosis or the outflow vein. Altogether 60 patients with failing AVG and restenosis in the venous anastomosis or the outflow vein were randomly assigned to either PTA, placement of a stent (E-Luminexx®) or stent graft (Fluency Plus®). After the procedure, patients with stent or stent graft received dual antiplatelet therapy for the next three months. Follow-up angiography was scheduled at 3, 6, and 12 months unless requested earlier due to suspected stenosis or malfunction of the access. Subsequently, angiography was performed only if requested by the clinician. During a median follow-up of 22.4 (IQR=5.7) months patients with PTA, stent, or stent graft required 3.1±1.7, 2.5±1.7, or 1.7±2.1 (P=0.031) secondary PTA interventions. The primary patency rates were 0, 18 and 65% at 12 months and 0, 18 and 37% at 24 months in the PTA, stent, and stent graft group respectively (P<0.0001). The cost of the procedures in the first two years was €7,900±€3,300 in the PTA group, €8,500±€4,500 in the stent group, and €7,500±€6,200 in the stent graft group (P=0.45). We conclude that the treatment of failing dialysis vascular access by the deployment of a stent graft significantly improves its primary patency rates and decreases the number of secondary PTA interventions; however, the reduction in costs for maintaining AVG patency is not significant.
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Affiliation(s)
- Jan Kavan
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
| | - Jaroslav Kudlicka
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
| | - Jan Malik
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
| | - Eva Chytilova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
| | - Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
| | - Marcela Slavikova
- Second Department of Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
| | - Patrik Matras
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
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11
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Tozzi M, Franchin M, Savio D, Comelli S, Di Maggio L, Carbonari L, Ebrahimi R, Fontana F, Piacentino F, Cervarolo MC, Palermo V, Piffaretti G. Drug-coated balloon angioplasty in failing haemodialysis arteriovenous shunts: 12-month outcomes in 200 patients from the Aperto Italian registry. J Vasc Access 2019; 20:733-739. [DOI: 10.1177/1129729819848609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: We evaluated the safety and technical and clinical outcomes of angioplasty with a drug-coated balloon for the management of venous stenosis in arteriovenous grafts and arteriovenous fistulas in patients undergoing haemodialysis. Methods: Data were obtained from an ongoing prospective, non-randomised registry conducted at three Italian centres. Patients were treated with a drug-coated balloon according to standard procedures in each participating centre. Evaluation was by colour Doppler imaging every 3 months. The primary end-point was primary assisted patency. The secondary end-point was the rate of assisted patency of the vascular access. Results: A total of 311 angioplasty procedures in 200 patients, (60.4% male), were analysed. The procedural success rate was 100%. A total of 192 treatments of restenosis were necessary in 81 patients during average 21 ± 8 months follow-up. Kaplan–Meier estimates indicated that 88.0%, 64.2% and 40.6% of treated lesions were free from restenosis at 6, 12 and 24 months, respectively. Including multiple angioplasty, circuit patency rates were 99.2%, 92.5% and 84.8% at 6, 12 and 24 months, respectively. Primary patency rates were highest in shunts treated de novo with drug-coated balloons. Risk of restenosis was associated with circuit age (p = 0.017), history of treatment with conventional angioplasty (p < 0.001) and the kind of balloon used during pre-dilation (p = 0.001). Conclusion: The results suggest that favourable long-term patency rates can be achieved with the drug-coated balloon in a varied population of patients with failing haemodialysis arteriovenous shunts treated under conditions of actual care.
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Affiliation(s)
- Matteo Tozzi
- Vascular Surgery Unit, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria, Varese, Italy
| | - Marco Franchin
- Vascular Surgery Unit, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria, Varese, Italy
| | - Daniele Savio
- Interventional Radiology-Neuroradiology Department, SG Bosco Hospital, Turin, Italy
| | - Simone Comelli
- Interventional Radiology-Neuroradiology Department, SG Bosco Hospital, Turin, Italy
| | - Luca Di Maggio
- Interventional Radiology-Neuroradiology Department, SG Bosco Hospital, Turin, Italy
| | | | | | - Federico Fontana
- Department of Radiology, Circolo University Teaching Hospital, University of Insubria, Varese, Italy
| | - Filippo Piacentino
- Department of Radiology, Circolo University Teaching Hospital, University of Insubria, Varese, Italy
| | - Maria Cristina Cervarolo
- Vascular Surgery Unit, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria, Varese, Italy
| | - Vincenzo Palermo
- Vascular Surgery Unit, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery Unit, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria, Varese, Italy
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12
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D’cruz RT, Leong SW, Syn N, Tiwari A, Sannasi VV, Singh Sidhu HR, Tang TY. Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis. J Vasc Access 2018; 20:345-355. [DOI: 10.1177/1129729818814466] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Sze Wai Leong
- Department of Surgery, Ng Teng Fong General Hospital, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alok Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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13
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Swinnen J“J, Hitos K, Kairaitis L, Gruenewald S, Larcos G, Farlow D, Huber D, Cassorla G, Leo C, Villalba LM, Allen R, Niknam F, Burgess D. Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses. J Vasc Access 2018; 20:260-269. [DOI: 10.1177/1129729818801556] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Endovascular treatment of autogenous arteriovenous haemodialysis fistula stenosis has high reintervention rates. We investigate the effect of drug-eluting balloons in the treatment of recurrent haemodialysis fistula stenosis. Methods: This is a randomised, controlled, investigator-initiated and run, prospective, blinded, multicentre trial. Patients with recurrent autogenous arteriovenous haemodialysis fistula stenosis received standard endovascular treatment plus drug-eluting balloon or standard endovascular treatment plus uncoated balloon (Sham). Primary endpoint was late lumen loss in trial area on ultrasound at 6 weeks, 3, 6 and 12 months. Secondary endpoints were freedom from reintervention to the Index Trial Area and decline in fistula flow (Qa). Interim analysis was performed at 6 months (unblinded due to timeliness). Results: Patients with 132 recurrent stenoses (48% in bare Nitinol stents) were randomised with 70 receiving drug-eluting balloon and 62 Sham. At 6 months, decline in late lumen loss was 0.23 ± 0.03 mm/month for Sham and 0.045 ± 0.03 mm/month for drug-eluting balloon arm, a significant difference (0.18 mm, p = 0.0002). At 12 months, this difference persisted at 0.12 mm (p = 0.0003). At 6 months, significant difference in late lumen loss for instent restenoses (p = 0.0004) was observed, with non-significant difference for unstented restenoses (p = 0.065). Mean time for freedom from reintervention was 10.14 months for Sham versus 42.39 months for drug-eluting balloon (p = 0.001). The same was shown for instent (p = 0.014) and unstented (p = 0.029) restenoses. Qa decline rate at 6 months was 36.89 mL/min/month (Sham) and 0.41 mL/min (drug-eluting balloon). The difference was significant (36.48 mL/min; p = 0.02) and persisted to 12 months (p = 0.44). Conclusion: Paclitaxel drug-eluting balloon significantly delays restenosis after angioplasty for recurrent autogenous arteriovenous haemodialysis fistula stenosis, persisting to 12 months. Drug-eluting balloon significantly increases freedom from reintervention at 12 months with these effects true in stented and unstented fistulas.
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Affiliation(s)
- Jan “John” Swinnen
- Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Kerry Hitos
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Lukas Kairaitis
- Western Renal Service, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Simon Gruenewald
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - George Larcos
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - David Farlow
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - David Huber
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - Gabriel Cassorla
- Clínica Alemana de Santiago and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christopher Leo
- Renal Centre, University Medicine Cluster, National University Hospital, Singapore
| | - Laurencia M Villalba
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - Richard Allen
- Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Farshid Niknam
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - David Burgess
- Department of Cardiology, Western Sydney University, Blacktown Hospital, Blacktown, NSW, Australia
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14
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Aurshina A, Hingorani A. Reply. J Vasc Surg 2018; 68:314-315. [DOI: 10.1016/j.jvs.2018.03.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022]
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