Dialysis Access Maintenance: Plain Balloon Angioplasty

Ratnam, Lakshmi; Karunanithy, Narayan; Mailli, Leto; Διαμαντόπουλος, Αθανάσιος; Morgan, Robert

doi:10.1007/s00270-023-03441-x

Cited by 6 publications

(1 citation statement)

References 56 publications

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“…Guidelines recommend treatment for CAS causative of > 50% lumen reduction with clinical/physiological abnormalities [6,9,10]. Percutaneous transluminal angioplasty (PTA) in the form of a plain balloon angioplasty (PBA) has been the mainstay of endovascular treatment [11], though recurrence is very common, with 23-76% patency at six months, and 9.5-45% at one year[6, [12][13][14][15][16][17]. Drug covered balloons (DCB) have shown non-inferiority to PBA in RCT settings [18,19] but long-term data beyond 6 months with regards to the cephalic arch remain limited.…”

Section: Introductionmentioning

confidence: 99%

Cephalic Arch Stenosis : An Analysis of Outcome by Type of First Intervention

Pisano,

Stevenson,

Kasthuri

et al. 2023

Preprint

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Background Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report outcomes based on CAS initial treatment on long-term follow-up. Methods Retrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via c2 or Fisher’s; nonparametric tests used for skewed data. Kaplan-Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP. Results 101 brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%,p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01). Conclusions: SG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity.

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Section: Introductionmentioning

confidence: 99%

Cephalic Arch Stenosis : An Analysis of Outcome by Type of First Intervention

Pisano,

Stevenson,

Kasthuri

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Dialysis Access Creation and Management: A Clinical Paradigm

Tay,

Trerotola,

Tan

2023

Cardiovasc Intervent Radiol

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Cephalic arch stenosis: an analysis of outcome by type of first intervention

Pisano,

Stevenson,

Kasthuri

et al. 2024

CVIR Endovasc

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Background Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS. Methods Retrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via χ2 or Fisher’s; nonparametric tests used for skewed data. Kaplan–Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP. Results One hundred one brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%, p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01). Conclusions SG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity.

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Dialysis Access Maintenance: Plain Balloon Angioplasty

Cited by 6 publications

References 56 publications

Cephalic Arch Stenosis : An Analysis of Outcome by Type of First Intervention

Cephalic Arch Stenosis : An Analysis of Outcome by Type of First Intervention

Dialysis Access Creation and Management: A Clinical Paradigm

Cephalic arch stenosis: an analysis of outcome by type of first intervention

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