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Friday, April 5, 2019

Use of Drug-Coated Balloons in Dysfunctional Arteriovenous Dialysis Access Treatment: The Effect of Consecutive Treatments on Lesion Patency


Clinical question
What is the outcome in arteriovenous (AV) access circuits that undergo repeat drug-coated balloon (DCB) angioplasty?

Take-away point
In this retrospective study of AV circuits undergoing consecutive DCB, there was no significant difference in the postintervention primary patency (PIPP).

Reference
Park, Joong-Won, et al. Sorafenib with or without concurrent transarterial chemoembolization in patients with advanced hepatocellular carcinoma: The phase III STAH trial. Journal of Hepatology. December, 2018. In Press.

Click here for abstract

Study design: Retrospective Longitudinal Analysis

Funding source: None identified.

Setting: University hospital setting - Greece.

Summary 


This is a retrospective longitudinal study evaluating the recurrent use of DCB in dysfunctional AV circuits. The authors evaluated 165 patients undergoing 257 procedures. From this cohort, the authors then selected the 38 patients who had a single lesion treated at minimum 2 times with a DCB. They then evaluated from this study population the postintervention primary patency (PIPP), with the goal to evaluate noninferiority of the second (repeat) intervention. 22/38 patients underwent two treatments with DCB, the remaining ranging from 3-6 treatments. The most common treatment site was cephalic vein. The authors concluded the use of repetitive DCB was safe from an AV access circuit standpoint and that recurrent use was noninferior to the first use with regard to PIPP. The authors did note that there was a significant increase in PIPP in patients undergoing a total of two interventions, favoring the second intervention (N= 22 for this population).


Commentary


This is a retrospective study with a relatively small number of patients that evaluates the use of repeat DCB in dysfunctional AV circuits. The authors noted that repeat use of DCB on the same lesion did not result in inferior primary patency rates. They did note a significant trend towards increased postintervention primary patency in patients who required a total of two interventions over the study period. This study suggests that consecutive DCB is safe with regard to the patency of the access circuit. However, given the recent literature surrounding overall risk regarding the use of DCB, it is unclear to me the impact on clinical practice change this article will have.

Post Author:
Daniel P. Sheeran, MD
Assistant Professor
Department of Radiology and Medical Imaging
Division of Vascular and Interventional Radiology
University of Virginia

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