Angioplasty of long venous stenoses in hemodialysis access: at last an indication for cutting balloon?

Abstract

Purpose: To compare the postintervention primary patency rates of cutting balloon angioplasty (CBA) with those of conventional percutaneous transluminal angioplasty (PTA) in the treatment of hemodialysis-related stenoses at least 2 cm long.

Materials and methods: This retrospective and controlled study included 29 patients with a hemodialysis-related stenosis at least 2 cm long. From August 2002 to August 2003, nine patients (PTA group, six upper-arm and three forearm fistulas) were treated with a conventional balloon (5-8 mm, 4 cm long). From September 2003 to December 2005, 20 patients (CBA group, 12 upper-arm and seven forearm fistulas; one polytetrafluoroethylene hemodialysis graft) were treated with a cutting balloon (5-7 mm, 1 cm long). The median follow-up was 22.1 months for the CBA group and 15.6 months for the PTA group. The Kaplan-Meier method was used to calculate the primary cumulative patency rates, and the log-rank test was used for comparison. Multivariate Cox models were generated by combining three variables: patient age, stenosis length, and treatment type (CBA or PTA).

Results: In the CBA group, the postintervention primary patency was 85% +/- 16 at 6 months, 70% +/- 20 at 1 year, and 32% +/- 26 at 18 months. In the PTA group, the postintervention primary patency was 56% +/- 32 at 6 months and 21% (range, 0%-53%) at 1 year. When comparing PTA versus CBA with the log-rank test, there was a statistically significant difference (P = .009). With the multivariate Cox models, treatment was again a statistically significant (P = .007) determinant of primary patency; patient age and stenosis length were not.

Conclusion: The use of a cutting balloon as the first-line treatment for stenoses at least 2 cm long significantly improves the postintervention primary patency rate.