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.
