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Mortality After Paclitaxel-Coated Device Use in Dialysis Access: A Systematic Review and Meta-Analysis.
- Source :
-
Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2019 Oct; Vol. 26 (5), pp. 600-612. Date of Electronic Publication: 2019 Aug 28. - Publication Year :
- 2019
-
Abstract
- Purpose: To report the risk of all-cause mortality in patients who underwent dialysis access treatment using paclitaxel-coated devices compared with percutaneous transluminal angioplasty (PTA) with an uncoated balloon. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials were performed to investigate the mortality outcomes associated with paclitaxel-coated devices in the treatment of patients with a failing dialysis access (last search date February 28, 2019). The primary endpoint was all-cause mortality. This analysis included 8 studies comparing paclitaxel-coated balloon (PCB) angioplasty (n=327) and PTA (n=331) in the treatment of failing dialysis access. None investigated paclitaxel-coated stents. Mortality data were pooled using a random effects model. Statistical heterogeneity was evaluated with a chi-square test and the I <superscript>2</superscript> statistic. Summary statistics are expressed as relative risk ratios (RR) with a 95% confidence interval (CI). Results: At the pooled mean follow-up of 13.5 months (median 12, range 6-24) all-cause mortality was similar in the PCB group (13.8%) compared with PTA (11.2%; RR 1.26, 95% CI 0.85 to 1.89, p=0.25; I <superscript>2</superscript> =0%). Subgroup analysis, stratified according to length of follow-up, confirmed that there were no statistically significant differences in mortality at short- and midterm follow-up [6-month (8 studies): 5.2% vs 4.8%, RR 1.24, 95% CI 0.62 to 2.47, p=0.55; 12-month (6 studies): 6.3% vs 6.0%, RR 1.06, 95% CI 0.43 to 2.63, p=0.90; and 24-month (3 studies): 19.0% vs 13.5%, RR 1.38, 95% CI 0.90 to 2.12, p=0.14). Conclusion: The analysis found no difference in short- to midterm mortality among patients treated with a drug-coated balloon compared with PTA. With proven benefit and no evidence of harm, the authors recommend ongoing use of PCB for the failing dialysis access.
- Subjects :
- Aged
Aged, 80 and over
Angioplasty, Balloon adverse effects
Arteriovenous Shunt, Surgical mortality
Blood Vessel Prosthesis Implantation mortality
Cardiovascular Agents administration & dosage
Female
Graft Occlusion, Vascular diagnostic imaging
Graft Occlusion, Vascular mortality
Graft Occlusion, Vascular physiopathology
Humans
Male
Middle Aged
Paclitaxel adverse effects
Prosthesis Design
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Time Factors
Treatment Failure
Angioplasty, Balloon instrumentation
Angioplasty, Balloon mortality
Arteriovenous Shunt, Surgical adverse effects
Blood Vessel Prosthesis Implantation adverse effects
Cardiovascular Agents adverse effects
Coated Materials, Biocompatible
Drug-Eluting Stents
Graft Occlusion, Vascular therapy
Paclitaxel administration & dosage
Renal Dialysis adverse effects
Renal Dialysis mortality
Vascular Access Devices
Subjects
Details
- Language :
- English
- ISSN :
- 1545-1550
- Volume :
- 26
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists
- Publication Type :
- Academic Journal
- Accession number :
- 31455140
- Full Text :
- https://doi.org/10.1177/1526602819872154