Drug Coated Balloons in Hemodialysis Access Circuits: A Meta-Analysis and Systematic Review

Background: Hemodialysis access stenoses are a major source of morbidity and cost for renal dialysis populations. With endovascular techniques a single access can be maintained for a longer period, although this often requires multiple balloon angioplasties (BA) with adjuncts such as high pressure or cutting balloons to treat areas of neointimal hyperplasia in the access circuit. Drug coated balloons (DCB) have been used to decrease recurrence of stenoses although the evidence is not yet definitive. This study sought to collate data from trials to assess 6 and 12 month target lesion revascularization as a measure of DCB efficacy compared to BA. Method(s): Embase, Medline and the Cochrane Central Registry were searched for randomised controlled trials evaluating DCB against BA for arteriovenous fistulas and grafts, central venous stenoses were excluded. The outcome was the need for revascularization due to index lesion restenosis within 6 and 12 months or access thrombosis. A random effects meta-analysis with generic inverse variance weighting was used to generate summary statistics for these outcomes. Result(s): 69 abstracts were identified from which seven studies were included for meta-analysis, totaling 707 access stenoses. All studies utilised paclitaxel coated balloons as intervention. At 6 months DCB showed a non-significant trend towards reduced restenosis (RR 0.74, 95% CI: 0.49 to 1.11, p=0.14). The 12 month results also showed no significant difference between DCB and BA (RR 0.91, 95% CI: 0.67 to 1.23, p=0.53). Conclusion(s): Although there was a reasonable amount of heterogeneity, the results presented show that routine use of DCB in hemodialysis access circuits should be reconsidered until further studies show subgroups that may benefit. It is possible that the continued hemodynamic disturbance in the fistula circuit does not allow for the same patency effects of paclitaxel seen in the peripheral arterial circulation.

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Artikel online veröffentlicht:
11. Mai 2021