Alexander Massmann1, Peter Fries2, Kerstin Obst-Gleditsch2, Peter Minko2, Roushanak Shayesteh-Kheslat3, Arno Buecker2. 1. Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany alexander.massmann@uks.eu. 2. Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany. 3. Department of General, Abdominal, and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
Abstract
PURPOSE: To report a retrospective observational analysis of standard balloon angioplasty (BA) vs. paclitaxel-coated balloon angioplasty (PCBA) for symptomatic central vein restenoses in patients with impaired native hemodialysis fistulas. METHODS: A retrospective review was conducted of 27 consecutive patients (15 men; mean age 66 ± 13.8 years, range 39-90) with 32 central vein stenoses (CVS; 6 axillary, 11 subclavian, 12 brachiocephalic, and/or 3 superior caval veins) treated successfully using BA. Freedom from reintervention after BA of de novo lesions was 7.4 ± 7.9 months (range 1-24). Twenty-five (92.6%) patients developed symptomatic restenoses and were treated one or more times by BA (n = 32) or PCBA (n = 20) using custom-made paclitaxel-coated balloons (diameter 6-14 mm). RESULTS: Technical (< 30% residual stenosis) and clinical (functional fistula) success rates for the initial and secondary angioplasty procedures were 100%. No minor/major procedure-associated complications occurred. Mean follow-up was 18.4 ± 17.5 months. Kaplan-Meier analysis for freedom from target lesion revascularization (TLR) found PCBA superior to BA (p = 0.029). Median freedom from TLR after BA was 5 months; after PCBA, > 50% of patients were event-free during the observation period (mean freedom from TLR 10 months). Restenosis intervals were prolonged by PCBA (median 9 months) vs. BA (median 4 months; p = 0.023). CONCLUSION: Paclitaxel-coated balloon angioplasty of central vein restenosis in patients with hemodialysis shunts yields a statistically significant longer freedom from TLR compared to standard balloon angioplasty.
PURPOSE: To report a retrospective observational analysis of standard balloon angioplasty (BA) vs. paclitaxel-coated balloon angioplasty (PCBA) for symptomatic central vein restenoses in patients with impaired native hemodialysis fistulas. METHODS: A retrospective review was conducted of 27 consecutive patients (15 men; mean age 66 ± 13.8 years, range 39-90) with 32 central vein stenoses (CVS; 6 axillary, 11 subclavian, 12 brachiocephalic, and/or 3 superior caval veins) treated successfully using BA. Freedom from reintervention after BA of de novo lesions was 7.4 ± 7.9 months (range 1-24). Twenty-five (92.6%) patients developed symptomatic restenoses and were treated one or more times by BA (n = 32) or PCBA (n = 20) using custom-made paclitaxel-coated balloons (diameter 6-14 mm). RESULTS: Technical (< 30% residual stenosis) and clinical (functional fistula) success rates for the initial and secondary angioplasty procedures were 100%. No minor/major procedure-associated complications occurred. Mean follow-up was 18.4 ± 17.5 months. Kaplan-Meier analysis for freedom from target lesion revascularization (TLR) found PCBA superior to BA (p = 0.029). Median freedom from TLR after BA was 5 months; after PCBA, > 50% of patients were event-free during the observation period (mean freedom from TLR 10 months). Restenosis intervals were prolonged by PCBA (median 9 months) vs. BA (median 4 months; p = 0.023). CONCLUSION:Paclitaxel-coated balloon angioplasty of central vein restenosis in patients with hemodialysis shunts yields a statistically significant longer freedom from TLR compared to standard balloon angioplasty.
Authors: Narayan Karunanithy; Irene Rebollo Mesa; Anthony Dorling; Francis Calder; Konstantinos Katsanos; Vikki Semik; Emily Robinson; Janet Peacock; Neelanjan Das; Colin Forman; Sarah Lawman; Kate Steiner; C Jason Wilkins; Michael G Robson Journal: Trials Date: 2016-05-12 Impact factor: 2.279