Paclitaxel-Coated Balloon Angioplasty for Dysfunctional Arteriovenous Fistulas

Efficacy of drug-coated balloon versus uncoated balloon for dysfunctional dialysis access: a systematic review and meta-analysis

BACKGROUND

Dysfunctional vascular access is a major cause of morbidity and mortality in patients undergoing hemodialysis, affecting both arteriovenous fistulas and grafts. The most optimal strategy to restore long-term patency has not been established. This meta-analysis compares drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty for dysfunctional vascular access.

METHODS

We performed a systematic literature search across multiple databases from inception to June 2024. Randomized-controlled trials (RCTs) comparing DCB and UCB in dialysis patients with dysfunctional vascular access were included. Risk ratios were pooled using a random-effects model.

RESULTS

Twenty-seven RCTs (2645 patients) were included. Target lesion patency (TLP) at 6 months was significantly superior in the DCB group (RR 1.22, 95% CI 1.07-1.39, p = 0.003). The two regimens were comparable for TLP at 3 months (RR 1.14, p = 0.24) and 12 months (RR 1.14, p = 0.10). The two regimens were comparable in terms of circuit patency rate, target-lesion revascularization, and all-cause mortality.

CONCLUSION

DCB has significantly superior TLP and a comparable risk of mortality to UCB. Further research is warranted to identify factors affecting outcomes following DCB angioplasty for dysfunctional dialysis access.

Development and validation of a prediction model for estimating patency rates after treatment of haemodialysis access dysfunction

OBJECTIVE

This study aims to develop a risk assessment model for predicting haemodialysis access dysfunction and to construct a nomogram.

METHOD

The clinical data of patients with haemodialysis access dysfunction treated at our hospital from October 2020 to January 2024 were retrospectively analysed. The least absolute shrinkage and selection operator regression method was used to filter variables and select predictors, while Cox regression was applied to filter variables and construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). Calibration was evaluated using bootstrap internal validation and the Hosmer-Lemeshow test. The clinical utility and applicability of the model were assessed through decision curve analysis (DCA) and the clinical impact curve (CIC). Subgroup analysis of risk factors for haemodialysis access dysfunction was performed using Kaplan-Meier survival curves.

RESULT

The study included 423 patients, and seven variables were used to construct the risk prediction model and nomogram for haemodialysis access dysfunction. The C-index of the prediction model was 0.783, and the time-dependent AUC (>0.8) at 6, 12, 18 and 24 months post-surgery indicated strong discriminatory ability. The calibration curve and Hosmer-Lemeshow test demonstrated good agreement between the prediction of the nomogram and the observed values. The DCA and CIC curves further confirmed the clinical practicability of the model.

CONCLUSION

A risk assessment model and nomogram for haemodialysis access dysfunction based on seven variables were successfully constructed. This model demonstrates good discrimination and calibration, offering valuable guidance for clinical decision-making and significant clinical utility.

Retrospective cohort study on the safety and efficacy of paclitaxel-coated balloon in the treatment of diabetic subpatellar artery disease

Paclitaxel can inhibit smooth muscle cell proliferation and migration, and reduce the risk of vascular restenosis after balloon dilation. Our study investigated the safety and efficacy of paclitaxel-coated balloon (PCB) treatment for diabetic subpatellar artery disease. In this study, 140 patients with diabetic subknee arterial disease treated in our hospital from January 2022 to December 2023 were selected as the study objects, and were divided into the control group (conventional balloon interventionization angioplasty) and the observation group (PCB interventionization angioplasty), with 70 cases in each group according to the differences in previous balloon interventionization. The safety and efficacy of the 2 treatments were compared. There was no significant difference in the primary patency rate 6 months after operation between the 2 groups (P > .05). There was significant difference in restenosis rate at 12 months after operation (P < .05). There was no significant difference in ankle-brachial index between the 2 groups before and 6 months after operation (P > .05). At 12 months after operation, ankle-brachial index of observation group was higher than that of control group, and the differences were statistically significant (P < .05). The improvement rate of walking impairment and 6 minutes walking distance in the observation group were significantly better than those in the control group, the difference was statistically significant (P < .05). There was no significant difference in the occurrence of adverse events between the 2 groups after operation (P > .05). For diabetic patients with subknee arterial disease, PCB treatment can ensure safety and improve clinical symptoms, and has good practical value.