Endovascular Treatment of Haemodialysis Arteriovenous Fistula with Drug-Coated Balloon Angioplasty: A Single-Centre Study

  • Jernej Lučev
  • Silva Breznik
  • Dejan Dinevski
  • Robert Ekart
  • Mitja Rupreht
Clinical Investigation
  • 60 Downloads

Abstract

Purpose

To evaluate the effect of percutaneous transluminal angioplasty (PTA) on haemodialysis fistulas utilising drug-coated balloons with plain balloon vessel preparation (DCB).

Materials and Methods

In the study group, 31 patients (16 men; mean age 62.8 ± 17.2 years) with failing arteriovenous fistulas were treated, with DCB, and compared with a control group (31 patients; 15 men; mean age 67.0 ± 8.44 years), in which only plain balloon PTA was performed. All stenoses were dilated with regular PTA balloons. After achieving haemodynamic success (< 30% residual stenosis), drug-coated balloons were used for drug administration in the study group. The follow-up intervals were 6, 12 and 24 months. Target lesion primary patency, primary assisted patency and secondary patency were compared. The statistical significance was set at 0.05.

Results

Target lesion primary patency was compared in both groups and was significantly higher in the study group (DCB) at 6 months (90.3 vs. 61.3%; p = 0.016), 12 months (77.4 vs. 29%; p = 0.0004) as well as 24 months (45.2 vs. 16.1%; p = 0.026). Kaplan–Meier survival curves also showed a significant difference for target lesion primary patency (534.2 vs. 315.7 days; p = 0.0004). There were no significant differences in target lesion primary assisted patency and in secondary patency. However, only 38.7% of patients in the study group were treated twice or more versus 80.6% in the control group (p = 0.002).

Conclusion

DCB increases target lesion primary patency during the first 24 months and decreases the rate of reinterventions.

Keywords

Haemodialysis fistula Percutaneous transluminal angioplasty Drug-coated balloon Vessel preparation Paclitaxel 

Notes

Acknowledgements

This work was previously presented as an electronic poster (P-114) during CIRSE 2017 meeting in Copenhagen, September 16–20 and as oral scientific presentation (B-0864) during the European Congress of Radiology (ECR) 2018 in Vienna, February 28–March 4.

Compliance with Ethical Standards

Conflict of interest

The authors declare that there are no conflicts of interests.

Ethical Approval

The authors declare that all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The authors declare that informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Bittl JA. Catheter interventions for hemodialysis fistulas and grafts. JACC Cardiovasc Interv. 2010;3(1):1–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Katsanos K, Karnabatidis D, Kitrou P, Spiliopoulos S, Christeas N, Siablis D. Paclitaxel-coated balloon angioplasty vs plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial. J Endovasc Ther. 2012;19(2):263–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Patane D, Giuffrida S, Morale W, L’Anfusa G, Puliatti D, Bisceglie P, et al. Drug-eluting balloon for the treatment of failing hemodialytic radiocephalic arteriovenous fistulas: our experience in the treatment of juxta-anastomotic stenoses. J Vasc Access. 2014;15(5):338–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Buturovic-Ponikvar J, Gubensek J, Arnol M, Adamlje T, Ceglar Z, Damevska G, et al. Renal replacement therapy in Slovenia: excerpts from 2013 data. Ther Apher Dial. 2016;20(3):223–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Asif A, Gadalean FN, Merrill D, Cherla G, Cipleu CD, Epstein DL, et al. Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study. Kidney Int. 2005;67(5):1986–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884–930.CrossRefGoogle Scholar
  7. 7.
    Feldman HI, Kobrin S, Wasserstein A. Hemodialysis vascular access morbidity. J Am Soc Nephrol JASN. 1996;7(4):523–35.PubMedGoogle Scholar
  8. 8.
    Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses a systematic review. J Vasc Surg. 2003;38(5):1005–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Long B, Brichart N, Lermusiaux P, Turmel-Rodrigues L, Artru B, Boutin JM, et al. Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis. J Vasc Surg. 2011;53(1):108–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Malka KT, Flahive J, Csizinscky A, Aiello F, Simons JP, Schanzer A, et al. Results of repeated percutaneous interventions on failing arteriovenous fistulas and grafts and factors affecting outcomes. J Vasc Surg. 2016;63(3):772–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol JASN. 2006;17(4):1112–27.CrossRefPubMedGoogle Scholar
  12. 12.
    Caplice NM, Wang S, Tracz M, Croatt AJ, Grande JP, Katusic ZS, et al. Neoangiogenesis and the presence of progenitor cells in the venous limb of an arteriovenous fistula in the rat. Am J Physiol Renal Physiol. 2007;293(2):F470–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Asif A, Lenz O, Merrill D, Cherla G, Cipleu CD, Ellis R, et al. Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: results of a prospective study. Kidney Int. 2006;69(10):1904–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Croatt AJ, Grande JP, Hernandez MC, Ackerman AW, Katusic ZS, Nath KA. Characterization of a model of an arteriovenous fistula in the rat: the effect of L-NAME. Am J Pathol. 2010;176(5):2530–41.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mezzano D, Pais EO, Aranda E, Panes O, Downey P, Ortiz M, et al. Inflammation, not hyperhomocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia. Kidney Int. 2001;60(5):1844–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Lai CC, Fang HC, Tseng CJ, Liu CP, Mar GY. Percutaneous angioplasty using a paclitaxel-coated balloon improves target lesion restenosis on inflow lesions of autogenous radiocephalic fistulas: a pilot study. J Vasc Interv Radiol JVIR. 2014;25(4):535–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Baek I, Hwang J, Park J, Kim H, Park JS, Kim DJ. Paclitaxel coating on the terminal portion of hemodialysis grafts effectively suppresses neointimal hyperplasia in a porcine model. J Vasc Surg. 2015;61(6):1575-82.e1.CrossRefPubMedGoogle Scholar
  18. 18.
    Kitrou PM, Katsanos K, Spiliopoulos S, Karnabatidis D, Siablis D. Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472). Eur J Radiol. 2015;84(3):418–23.CrossRefPubMedGoogle Scholar
  19. 19.
    Portugaller RH, Kalmar PI, Deutschmann H. The eternal tale of dialysis access vessels and restenosis: are drug-eluting balloons the solution? J Vasc Access. 2014;15(6):439–47.CrossRefPubMedGoogle Scholar
  20. 20.
    Mortamais J, Papillard M, Girouin N, Boutier R, Cougnaud L, Martin X, et al. Endovascular treatment of juxta-anastomotic venous stenoses of forearm radiocephalic fistulas: long-term results and prognostic factors. J Vasc Interv Radiol JVIR. 2013;24(4):558–64 (quiz 65).CrossRefPubMedGoogle Scholar
  21. 21.
    Zeller T. Current state of endovascular treatment of femoro-popliteal artery disease. Vasc Med (London, England. 2007;12(3):223–34.CrossRefGoogle Scholar
  22. 22.
    Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603–10.CrossRefPubMedGoogle Scholar
  23. 23.
    Owens CD, Wake N, Kim JM, Hentschel D, Conte MS, Schanzer A. Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease. J Vasc Access. 2010;11(4):329–34.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001;37(1 Suppl 1):S137–81.Google Scholar
  25. 25.
    Baker LD Jr, Johnson JM, Goldfarb D. Expanded polytetrafluoroethylene (PTFE) subcutaneous arteriovenous conduit: an improved vascular access for chronic hemodialysis. Trans Am Soc Artif Intern Organs. 1976;22:382–7.PubMedGoogle Scholar
  26. 26.
    Ravani P, Brunori G, Mandolfo S, Cancarini G, Imbasciati E, Marcelli D, et al. Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: a prospective multicenter study. J Am Soc Nephrol JASN. 2004;15(1):204–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, et al. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2003;63(1):323–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Saran R, Dykstra DM, Pisoni RL, Akiba T, Akizawa T, Canaud B, et al. Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS. Nephrol Dial Transpl. 2004;19:2334–40.CrossRefGoogle Scholar
  29. 29.
    Brunori G, Ravani P, Mandolfo S, Imbasciati E, Malberti F, Cancarini G. Fistula maturation: doesn’t time matter at all? Nephrol Dial Transpl. 2005;20(4):684–7.CrossRefGoogle Scholar
  30. 30.
    Wang N, Fulcher J, Abeysuriya N, Adams M, Lal S. Predictors of successful chronic total occlusion percutaneous coronary interventions: a systematic review and meta-analysis. Heart. 2018;104(6):517–24.CrossRefPubMedGoogle Scholar
  31. 31.
    Kleber FX, Mathey DG, Rittger H, Scheller B. How to use the drug-eluting balloon: recommendations by the German consensus group. EuroIntervention. 2011;7(Suppl K):K125-8.PubMedGoogle Scholar
  32. 32.
    Posa A, Hemetsberger R, Petnehazy O, Petrasi Z, Testor M, Glogar D, et al. Attainment of local drug delivery with paclitaxel-eluting balloon in porcine coronary arteries. Coron Artery Dis. 2008;19(4):243–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Tepe G, Laird J, Schneider P, Brodmann M, Krishnan P, Micari A, et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015;131(5):495–502.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Herten M, Torsello GB, Schönefeld E, Stahlhoff S. Critical appraisal of paclitaxel balloon angioplasty for femoral–popliteal arterial disease. Vasc Health Risk Manag. 2016;12:341–56.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Marzullo RAA, Biondi-Zoccai G, et al. Drug-eluting balloon technology. Card Interv Today. 2011;2011:40–9.Google Scholar
  36. 36.
    Bountouris I, Kristmundsson T, Dias N, Zdanowski Z, Malina M. Is repeat PTA of a failing hemodialysis fistula durable? Int J Vasc Med. 2014;2014:6.Google Scholar
  37. 37.
    Speck U, Scheller B, Hamm B. Drug-coated balloons for restenosis prophylaxis. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 2014;186(4):348–58.PubMedGoogle Scholar
  38. 38.
    Scheller B, Speck U, Abramjuk C, Bernhardt U, Bohm M, Nickenig G. Paclitaxel balloon coating, a novel method for prevention and therapy of restenosis. Circulation. 2004;110(7):810–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Yin S, Bhattacharya R, Cabral F. Human mutations that conferpaclitaxel resistance. Mol Cancer Ther. 2010;9(2):327.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Sugimoto K, Higashino T, Kuwata Y, Imanaka K, Hirota S, Sugimura K. Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency. Eur Radiol. 2003;13(7):1615–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Soder HK, Manninen HI, Rasanen HT, Kaukanen E, Jaakkola P, Matsi PJ. Failure of prolonged dilation to improve long-term patency of femoropopliteal artery angioplasty: results of a prospective trial. J Vasc Interv Radiol JVIR. 2002;13(4):361–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Lantis JC II, Boone D. Standard versus prolonged inflation time in balloon angioplasty of atherosclerotic rat aortas. J Vasc Surg. 2011;54(3):925.CrossRefGoogle Scholar
  43. 43.
    Humphrey WR, Simmons CA, Toombs CF, Shebuski RJ. Induction of neointimal hyperplasia by coronary angioplasty balloon overinflation: comparison of feeder pigs to Yucatan minipigs. Am Heart J. 1994;127(1):20–31.CrossRefPubMedGoogle Scholar
  44. 44.
    Pavo N, Samaha E, Sabdyusheva I, von Strandmann RP, Stahnke S, Plass CA, et al. Coating of intravascular balloon with paclitaxel prevents constrictive remodeling of the dilated porcine femoral artery due to inhibition of intimal and media fibrosis. J Mater Sci Mater Med. 2016;27:131.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Medical Center MariborMariborSlovenia
  2. 2.Institute of Biomedical InformaticsUniversity of Maribor, Faculty of MedicineMariborSlovenia
  3. 3.Clinic for Internal Medicine, Department of DialysisUniversity Medical Center MariborMariborSlovenia

Personalised recommendations