Paclitaxel-coated balloon in the treatment of recurrent dysfunctional arteriovenous access, real-world experience and longitudinal follow up.
AIM
Dysfunctional arteriovenous (AV) access remains a significant cause of morbidity and hospital admission for patients with end stage renal failure on haemodialysis. This study was performed to evaluate the impact of paclitaxel-coated Balloon (PCB) on the patency of AV access with recurrent stenoses.


METHODS
We retrospectively studied haemodialysis patients who presented to our centre with recurrent AV access dysfunction and compared intervention-free patency using plain balloon versus PCB.


RESULTS
A total of 147 patients were followed up longitudinally. Intervention-free patency was better following PCB compared to previous intervention using plain balloons (6.4 ± 5.8 versus 4.0 ± 3.7, P < 0.01). The 3- and 6-month patency rates after PCB were significantly better compared to standard plain angioplasty balloon: 69.4% versus 52.4%, P < 0.01 and 42.9% versus 15.6%, P < 0.01 respectively. Kaplan-Meier survival analysis of circuit patency demonstrated the superiority of PCB over plain balloon angioplasty in both arteriovenous fistula and arteriovenous graft (P < 0.01 and P = 0.01 respectively) although the patency of arteriovenous fistula remained significantly better than arteriovenous graft following interventions with PCB (P < 0.01). Age of AV access and the number of previous interventions were found to be significant predictors of patency following PCB intervention.


CONCLUSION
Arteriovenous access intervention with PCB was shown to be superior compared to plain balloon in the treatment of both non-thrombosed and thrombosed AV accesses in our multi-ethnic population.
['Phang|Chee Chin|CC|', 'Tan|Ru Yu|RY|', 'Pang|Suh Chien|SC|', 'Tan|Chee Wooi|CW|', 'Teh|Swee Ping|SP|', 'Cheng|Rui-Wern|RW|', 'Kho|Yu Xuan|YX|', 'Chong|Tze Tec|TT|', 'Gogna|Apoorva|A|', 'Foo|Wai Yin|WY|', 'Tan|Chieh Suai|CS|']
D000800:Angioplasty, Balloon D000972:Antineoplastic Agents, Phytogenic D001166:Arteriovenous Shunt, Surgical D020099:Coated Materials, Biocompatible D005260:Female D006801:Humans D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D017239:Paclitaxel D011183:Postoperative Complications D006435:Renal Dialysis D012086:Reoperation D013927:Thrombosis D016896:Treatment Outcome D062666:Vascular Access Devices D058017:Vascular Grafting D014654:Vascular Patency
paclitaxel-coated balloon haemodialysis angioplasty arteriovenous fistula arteriovenous graft thrombolysis