Drug-Eluting Balloon Versus Plain Balloon Angioplasty For The Treatment of Failing Hemodialysis Access: A Systematic Review and Meta-analysis

Abstract

Background: Hemodialysis access dysfunction is the major cause of hospitalization for patients undergoing hemodialysis due to stenosis at the anastomotic site. Our purpose is to perform a meta-analysis comparing target lesion primary patency rates at 6 months and one year, and major procedure-associated complications between drug-eluting balloon (DEB) and plain balloon angioplasty (PBA) for the treatment of arteriovenous fistula (AVF) or synthetic arteriovenous graft (AVG) stenosis.

Methods: PubMed, Embase, and MEDLINE databases were screened up to December 2018 to compare target lesion primary patency and complications between DEB and PBA. Two independent reviewers identified studies fulfilling our inclusion/exclusion criteria, extracted relevant data, and assessed quality. Fixed- or random-effects models were used to calculate overall effect estimates.

Results: Our literature search identified 10 articles eligible for inclusion in the review and analysis. DEB provided significantly higher target lesion primary patency rates for failing hemodialysis access than did PBA at 6 months [70% vs. 54%; odds ratio (OR), 2.71, 95% confidence interval (CI), 1.51 to 4.85; P < 0.01] and one year (59% vs. 37%; OR, 3.12, 95% CI, 2.14 to 4.55; P < 0.01). No major procedure-associated complications were observed in the 2 groups.

Conclusions: DEB is an effective and safe technology that can significantly prolong 6-month and one-year target lesion primary patency for failing hemodialysis access when compared to PBA.