MP641DRUG COATED BALLOONS REDUCE THE RISK OF RESTENOSIS IN HEMODIALYSIS PATIENTS WITH RECURRENT STENOSIS OF ARTERIOVENOUS FISTULA

Abstract

Background: Aim of this study was to evaluate the early and mid-term outcomes of drug-coated balloons (DCBs) in hemodialysis patients with recurrent stenosis of arteriovenous fistula. Materials and methods: Between July 2013 and June 2016 38 hemodialysis patients with recurrent stenosis of arteriovenous fistula underwent endovascular treatment with a DCB. All patients were previously treated at the target lesion with a standard balloon angioplasty (BA). The intervals in months between the standard BA and the procedure with DCB (time BA-DCB) and between the procedure with DCB and the new restenotic lesion (time DCBrestenosis) were evaluated and compared with T-test. Estimated outcomes at 2 years in terms of survival, primary patency, primary assisted patency, secondary patency, and freedom from target lesion restenosis were assessed with Kaplan-Meier curves. Results: Intraprocedural technical success was obtained in 97.4% of the cases. During the follow-up (mean duration 14.3 months, range 2-33) 7 patients died with an estimated 2-year survival rate of 72.9%. Furthermore, 19 patients (50%) developed a new restenotic lesion at the target lesion with an estimated 2-year freedom from target lesion restenosis of 63.2%. Mean time BA-DCB was 6.4 months, and the mean time DCB-restenosis was 7.9 months with a statistically significant difference at T-test (P<0.001). Finally, estimated 2-year rates of primary patency, primary assisted patency, and secondary patency were 40.8%, 73.1%, and 82.5%, respectively. Conclusions: In our experience DCBs were safe and effective in the treatment of recurrent stenosis in hemodialysis patients with failing arteriovenous fistula. Half of patients had no new restenotic lesion at the target lesion during the follow-up. In patients with a new restenosis the time to new restenotic lesion was longer respect to that necessary to have a new restenosis after BA. Finally, the great difference in terms of primary and primary assisted patencies at 2 years demonstrates that a strict collaboration between nephrologists and vascular surgeons is mandatory to avoid the failure of the vascular access.