Ranger™ paclitaxel-coated balloon versus conventional balloon angioplasty for treatment of failing arteriovenous fistulas and grafts in haemodialysis patients: A retrospective cohort study

2021 ◽  
pp. 112972982110670
Author(s):  
Shereen XY Soon ◽  
Ru Yu Tan ◽  
Suh Chien Pang ◽  
Charyl JQ Yap ◽  
Ankur Patel ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cohort Study ◽  
Balloon Angioplasty ◽  
Antiplatelet Agent ◽  
Target Lesion ◽  
End Stage Renal Failure ◽  
Arteriovenous Fistulas ◽  
Conventional Balloon Angioplasty ◽  
End Stage ◽  
Mean Time

Background: Aim was to compare the safety and patency efficacy outcomes between Ranger™ paclitaxel-coated balloon (PCB)- versus conventional balloon angioplasty (POBA) in the treatment of haemodialysis access-related conduit stenosis. Methods: Retrospective single-centre, multi-investigator, consecutive, double-arm comparative cohort study. About 130 end-stage renal failure Asian patients with dysfunctional arteriovenous fistula (AVF) or arteriovenous graft underwent PCB or POBA fistuloplasty between November 2018 and June 2020. All stenotic lesions were prepared with high pressure non-compliant balloon angioplasty prior to PCB angioplasty. All patients received at least one antiplatelet agent for 3 months duration post procedure. Results: Mean age was 66.0 ± 10 years and 79/130 (61%) were males. PCB arm ( n = 65) versus POBA arm ( n = 65). Majority were AVFs circuits (122/130, 94%). Main indication for intervention was dropping access flow (98/130, 76%). About 172 lesions were treated (56% POBA, 44% PCB), and the juxta-anastomosis (JAS) was the main target lesion (87/172, 51%). There were no significant differences in safety outcomes (30-day adverse events, access thrombosis, abandoned AVF and death) between treatment groups. Mean time to target lesion reintervention (TLR) was longer in PCB-treated lesions (7.1 ± 2.7 vs 5.8 ± 3.2 months, p = 0.03), especially amongst recurrent lesions (7.3 ± 2.4 vs 5.7 ± 3.2, p = 0.02). Mean time to circuit reintervention was also longer in PCB-treated circuits (6.9 ± 2.8 vs 5.8 ± 3.7months, p = 0.04). There were 16 deaths (12%), all attributed to patient’s underlying comorbidities. Conclusions: Fistuloplasty with Ranger™ PCB for failing arteriovenous circuits in end-stage renal failure patients, is a safe and efficacious modality compared to POBA in terms of longer freedom from TLR.

scholarly journals Vascular access for hemodialysis: creation, functioning, and complications (Data of the Hospital of Kaunas University of Medicine)

Medicina ◽  
2010 ◽  
Vol 46 (8) ◽  
pp. 550 ◽  
Author(s):  
Sondra Kybartienė ◽  
Inga Skarupskienė ◽  
Edita Žiginskienė ◽  
Vytautas Kuzminskis
Keyword(s):  
Renal Failure ◽  
Vascular Access ◽  
Ischemic Brain ◽  
End Stage Renal Failure ◽  
Arteriovenous Fistulas ◽  
The Mean ◽  
Group 2 ◽  
End Stage ◽  
Complications Rate ◽  
Mean Time

Background. There are no data about arteriovenous fistulas (AVF) formation, survival, and complications rate in patients with end-stage renal failure in Lithuania. Material and methods. We analyzed the data of patients (N=272) with end-stage renal failure, dialyzed at the Hospital of Kaunas University of Medicine from January 1, 2000, until March 30, 2010, and identified 368 cases of AVF creation. The patients were divided into two groups: group 1 included the patients with an AVF that functioned for <15 months (n=138) and group 2 included patients with an AVF that functioned for ≥15 months (n=171). Results and conclusions. Less than half (47%) of the patients started planned hemodialysis and 51% of the patients started hemodialysis urgently. The mean time of AVF functioning was 15.43±8.67 months. Age, gender, the kidney disease, and time of AVF maturation had no influence on AVF functioning time. AVFs of the patients who started planned hemodialysis functioned longer as compared to AVFs of the patients who started hemodialysis urgently (P<0.05). Hospitalization time of the patients who started hemodialysis urgently was longer as compared that of the patients who had a matured AVF (37.63±20.55 days vs. 16.54±9.43 days). The first vascular access had better survival than repeated access. AVF survival in patients with ischemic brain vascular disease was worse than in patients without this comorbidity.

scholarly journals Treatment of cephalic arch stenosis in dysfunctional arteriovenous fistulas with paclitaxel-coated versus conventional balloon angioplasty

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ren Kwang A. Tng ◽  
Ru Yu. Tan ◽  
Shereen X. Y. Soon ◽  
Suh Chien. Pang ◽  
Chieh Suai. Tan ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Retrospective Cohort ◽  
De Novo ◽  
Target Lesion ◽  
Primary Patency ◽  
Index Procedure ◽  
Arteriovenous Fistulas ◽  
Conventional Balloon Angioplasty ◽  
Plain Old Balloon Angioplasty ◽  
Mean Time

Abstract Background Treatment of cephalic arch stenosis (CAS) with standard plain old balloon angioplasty (POBA) in dysfunctional arteriovenous fistulas (AVF), is associated with early re-stenosis and higher failure rates compared to other lesions. Paclitaxel-coated balloons (PCB) may improve patency rates. This is a retrospective cohort study. Patients who underwent POBA or PCB for CAS over a 3-year period were included. Outcomes compared were circuit primary patency rates (patency from index procedure to next intervention), circuit primary assisted-patency rates (patency from index procedure to thrombosis), and target lesion (CAS) patency rates (stenosis > 50%) at 3, 6 and 12 months. Results Ninety-one patients were included. Sixty-five (71.4%) had POBA, while 26 (28.6%) had PCB angioplasty. There were 62 (68.1%) de-novo lesions. CAS was the only lesion that needed treatment in 24 (26.4%) patients. Circuit primary patency rates for POBA versus PCB groups were 76.2% vs. 60% (p = 0.21), 43.5% vs. 36% (p = 0.69) and 22% vs. 9.1% (p = 0.22) at 3, 6 and 12-months respectively. Circuit assisted-primary patency rates were 93.7% vs. 92% (p = 1.00), 87.1% vs. 80% (p = 0.51) and 76.3% vs. 81.8% (p = 0.77), whilst CAS target lesion intervention-free patency rates were 79.4% vs. 68% (p = 0.40), 51.6% vs. 52% (p = 1.00) and 33.9% vs. 22.7% (p = 0.49) at 3, 6 and 12-months respectively. Estimated mean time to target lesion intervention was 215 ± 183.2 days for POBA and 225 ± 186.6 days for PCB (p = 0.20). Conclusion Treatment of CAS with PCB did not improve target lesion or circuit patency rates compared to POBA.

scholarly journals A Report of Two Cases of Hazards Associated with High Flow Arteriovenous Fistula in ESRD Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Vipuj Shah ◽  
Rakesh Navuluri ◽  
Yolanda Becker ◽  
Mary Hammes
Keyword(s):  
Renal Failure ◽  
Arteriovenous Fistula ◽  
Cardiac Failure ◽  
High Flow ◽  
End Stage Renal Failure ◽  
Arteriovenous Fistulas ◽  
End Stage ◽  
Prospective Monitoring ◽  
Esrd Patients ◽  
Time Point

High flow arteriovenous fistulas are a common clinical entity affecting patients with end-stage renal failure receiving hemodialysis. Given the difficulty in predicting who will develop a high flow arteriovenous fistula the exact prevalence is unclear. We present two cases of patients with high flow arteriovenous fistula that developed clinical cardiac failure at a time point after the fistula was placed with findings of significant cephalic arch stenosis. Both patients required treatment of cephalic arch stenosis with balloon angioplasty with subsequent surgical aneurism resection. Accurate and timely diagnosis of high flow arteriovenous hemodynamics by prospective monitoring of volumetric flow and cardiac function is required to halt this process prior to cardiac compromise.

scholarly journals World’s First Experience Treating TASC II C and D Tibial Occlusive Disease Using the Selution SLR Sirolimus-Eluting Balloon: Six-Month Results From the PRESTIGE Study

2021 ◽  
pp. 152660282110074
Author(s):  
Tjun Yip Tang ◽  
Charyl Yap ◽  
Shereen Xue Yun Soon ◽  
Sze Ling Chan ◽  
QingWei Shaun Lee ◽  
...  
Keyword(s):  
Renal Failure ◽  
Clinical Success ◽  
Target Lesion ◽  
Lesion Length ◽  
Success Rates ◽  
Technical Success ◽  
Free Survival ◽  
End Stage Renal Failure ◽  
Technical Success Rate ◽  
End Stage

Purpose: The performance of sirolimus-coated devices has not been studied in patients with chronic limb-threatening ischemia patients. PRESTIGE aims to investigate the 6-month efficacy and safety profile of the Selution Sustained Limus Release (SLR) sirolimus-eluting balloon for treatment of TASC II C and D tibial occlusive lesions in patients with CLTI. Materials and Methods: PRESTIGE is a pilot prospective, nonrandomized, single-arm, multi-investigator, single-center clinical study. Endpoints were adverse event-free survival at 1 month, technical success rate, primary tibial patency at 6 months, limb salvage success, target lesion revascularization (TLR), and amputation free survival (AFS). Results: A total of 25 patients were included. There were 17 (68.0%) males; mean age, 63.7±9.73 years. CLTI severity was based on the Rutherford scale (R5=25/25; 100.0%). Significant comorbidities included diabetes mellitus (n=22; 88.0%) and end-stage renal failure (n=11; 44.0%). A total of 33 atherosclerotic lesions were treated (TASC II D=15 (45.5%)). Mean lesion length treated was 191±111 mm. Technical success was 100%. Primary tibial patency at 6 months was 22/27 (81.5%) and freedom from clinically driven TLR was 25/30 (83.3%). AFS was 21/25 (84.0%; 3 deaths and 1 major lower extremity amputation). Mean Rutherford score improved from 5.00 at baseline to 1.14±2.10 (p<0.05) at 6 months. There was a wound healing rate of 13/22 (59.1%) and 17/21 (81.0%) at 3 and 6 months respectively. Conclusions: Selution SLR drug-eluting balloon is a safe and efficacious modality in treating complex tibial arterial occlusive lesions in what is an otherwise frail cohort of CLTI patients, with a high prevalence of diabetes and end-stage renal failure. Technical and clinical success rates are high and 6-month target lesion patency and AFS are more than satisfactory.

scholarly journals Angioplasty for dysfunctional arteriovenous fistulas: a meta-analysis of recent randomized controlled trials compared paclitaxel-coated balloon versus conventional balloon angioplasty

2021 ◽  
Author(s):  
Qin Yang ◽  
Yi Zhou ◽  
Kui Cai ◽  
Yufang Chen ◽  
Congying Xia
Keyword(s):  
Randomized Controlled Trials ◽  
Balloon Angioplasty ◽  
Meta Analysis ◽  
Neointimal Hyperplasia ◽  
Target Lesion ◽  
Primary Patency ◽  
Controlled Trials ◽  
Arteriovenous Fistulas ◽  
Randomized Controlled ◽  
Conventional Balloon Angioplasty

Abstract Background Stenosis in arteriovenous fistulas (AVF) due to neointimal hyperplasia is one of the most common causes of hemodialysis vascular access dysfunction. Treating patients with dysfunctional AVF with drug-coated balloon (DCB) angioplasty may potentially improve outcomes. This systematic review aimed to compare the effectiveness and safety of DCB angioplasty versus conventional balloon angioplasty by pooling evidence from the most recent randomized controlled trials. Methods We conducted a comprehensive literature search in the Medline, Embase, and Cochrane central databases. Two independent researchers screened the article, extracted interest and evaluated included studies for risk of bias. Pooled estimation was conducted in terms of 6-month target-lesion primary patency (TLPP) and target-lesion reintervention (TLR), as well as other outcomes. Results were expressed with odds ratio (OR) and 95% confidence interval (CI). Results A total of 4 RCTs were identified and included in the meta-analyses, with 911 participants. There was no significant increase in rates of 6-month TLPP (OR 1.63, 95%CI 0.39–6.79, p = 0.35), or decrease in 6-month TLR (OR 0.45, 95%CI 0.17–1.19 p = 0.07) in patients who received DCB as compared to those who received conventional balloon angioplasty. Similarly, we found no difference in the 6-month access circuit primary patency and reinvention between the two groups. Conclusion There was no evidence supporting that DCB has a statistically significant higher rate of TLPP and lower rates of TLR in the treatment of dysfunctional AVF than conventional balloon angioplasty. However, DCB was non-inferior to conventional balloon angioplasty in terms of safety. Therefore, further study is needed to clarify whether DCB angioplasty can benefit hemodialysis patients with dysfunction AVF.

The percutaneous endovascular fistula for haemodialysis

2019 ◽  
Vol 4 (5) ◽  
pp. 262-264
Author(s):  
Karen Tullett
Keyword(s):  
Renal Failure ◽  
Clinical Nurse Specialist ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
End Stage Renal Failure ◽  
Arteriovenous Fistulas ◽  
End Stage

Karen Tullett, a haemodialysis access clinical nurse specialist, describes the advantages of percutaneously created arteriovenous fistulas for end stage renal failure patients

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