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Drug-Coated Balloon Angioplasty in Hemodialysis Circuits: A Systematic Review and Meta-Analysis.
- Source :
-
Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2019 Apr; Vol. 30 (4), pp. 483-494.e1. Date of Electronic Publication: 2019 Mar 08. - Publication Year :
- 2019
-
Abstract
- Purpose: To perform a systematic review and meta-analysis assessing patency outcomes following drug-coated balloon angioplasty (DCBA) in hemodialysis circuits.<br />Materials and Methods: MEDLINE and EMBASE systematic searches were performed from inception to November 2018 to identify comparative studies assessing DCBA vs plain old balloon angioplasty (POBA) in hemodialysis circuits. Abstract selection, data extraction, and quality assessment were performed by 2 independent reviewers. Primary outcome was loss of target lesion patency at 3, 6, 12, and 24 months for autogenous arteriovenous fistula (AVF), prosthetic arteriovenous graft (AVG), and hemodialysis-related central venous stenosis.<br />Results: Twelve studies comprising 908 patients were included. There was a significant improvement in patency among AVF after DCBA vs POBA at 3, 6, 12, and 24 months (odds ratio 0.58 [95% confidence interval, 0.36-0.94]; odds ratio 0.40 [95% confidence interval 0.23-0.70]; odds ratio 0.39 [95% confidence interval, 0.25-0.61]; and odds ratio 0.20 [95% confidence interval, 0.07-0.62]). This benefit persisted on subgroup analysis of randomized controlled trials (RCTs) only. Meta-analysis of results specific to AVG could not be performed, as only 1 RCT was identified that favored DCBA. Hemodialysis-associated central vein stenosis did not demonstrate a significant difference in patency rates between DCBA and POBA on meta-analysis. Twelve-month mortality and same-day complication rates did not differ between arms.<br />Conclusions: Significant improvement in patency was identified with DCBA in AVF at 3, 6, 12, and 24 months. A single comparative study identified benefit of DCBA use in the AVG group. No significant benefit was identified with DCBA for central stenosis.<br /> (Copyright © 2019 SIR. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Angioplasty, Balloon adverse effects
Arteriovenous Shunt, Surgical mortality
Blood Vessel Prosthesis Implantation mortality
Cardiovascular Agents adverse effects
Female
Graft Occlusion, Vascular etiology
Graft Occlusion, Vascular mortality
Graft Occlusion, Vascular physiopathology
Humans
Male
Middle Aged
Recurrence
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
Angioplasty, Balloon instrumentation
Arteriovenous Shunt, Surgical adverse effects
Blood Vessel Prosthesis Implantation adverse effects
Cardiovascular Agents administration & dosage
Coated Materials, Biocompatible
Graft Occlusion, Vascular therapy
Renal Dialysis
Vascular Access Devices
Subjects
Details
- Language :
- English
- ISSN :
- 1535-7732
- Volume :
- 30
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of vascular and interventional radiology : JVIR
- Publication Type :
- Academic Journal
- Accession number :
- 30857987
- Full Text :
- https://doi.org/10.1016/j.jvir.2019.01.012