Efficacy of High-Pressure Balloon for the Treatment of Arteriovenous Fistula Stenosis: A Meta-Analysis

Objective: The objective of the present study was to compare the effectiveness of high-pressure balloon (HPB) versus conventional balloon (CB) angioplasty in treating arteriovenous fistula (AVF) stenosis. Materials and Methods: A meta-analysis was conducted using data acquired from PubMed, EMBASE, the Cochrane Library, SinoMed, CNKI, WanFang, and VIP databases from the time the databases were established to December 2020. All analyses included in the studies comprised the subgroups of HPB and CB. The patency rates of AVF were compared between 2 groups at 3, 6, and 12 months after operation. Results: Seven studies comprising 364 patients were included in the meta-analyses. The pooled results revealed that restenosis rate of AVFs treated with HPB was significantly lower than that of AVFs treated with CB at 3 months (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.16 to 0.61, p<0.001) and 6 months after operation (OR= 0.29, 95% CI = 0.11 to 0.79, p = 0.01). In addition, the technical success rate of HPB groups was higher (OR = 0.13, 95% CI = 0.05 to 0.36, p<0.001). However, no significant difference was observed between HPB and CB groups at 12 months after operation (OR = 0.68, 95% CI = 0.30 to 1.52, p = 0.35). No significant publication bias was observed in the analyses. Conclusion: High-pressure balloon is a potential option for the treatment of AVF stenosis, with a lower 3- and 6-month restenosis rate than CB. However, 12-month patency rate of HPB was not superior to CB. Therefore, further studies should be conducted to investigate the mechanisms of restenosis after angioplasty.

Arteriovenous Fistula Stenosis: A Case Report

Background: Arteriovenous fistula (AVF) has better rate of patency and lower rate of complication compared to other vascular access for hemodialysis. One priority to be concerned is access failure for hemodialysis access is common findings and correspond with high healthcare cost, morbidity and mortality. Objective: This case report aimed to elaborate the proper management of patient with arterio fistula stenosis. Case Illustration: A man, 64 years old, stage V CKD with AVF in his left arm for hemodialysis access was admitted to our hospital due to difficulty in cannulation during his last hemodialysis. He had AVF For Hemodialysis access for two years. About 1 month before, he undergone surgery for creation of AVF for hemodialysis access in his right arm, but AVF was failed to reach maturation. Based on vascular doppler ultrasound (DUS) done in AVF of the left arm revealed there was stenosis in the juxta-anastomosis site and cephalic venous stenosis. Angioplasty was done in anastomose AVF and implantation of venous stent in the left cephalic vein. Conclusion: For patients on hemodialysis, vascular access is considered as the lifeline. Complications related to Vascular access is associated with morbidity and reduced quality of life. Surgery often difficult to do as readily as a percutaneous approach. In more than 80% of hemodialysis access underwent percutaneous interventions, flow was successfully restored. Based on this success rate, it has replaced surgical revision as the treatment of stenosis AVF.

Efficacy of high-pressure balloon for the treatment of arteriovenous fistula stenosis: a meta-analysis

ObjectiveThe objective of the present study was to compare the effectiveness of high-pressure balloon (HPB) versus conventional balloon angioplasty (BA) in treating arteriovenous fistula (AVF) stenosis.Materials and MethodsA meta-analysis was conducted using data acquired from PubMed, EMBASE, the Cochrane Library, SinoMed, CNKI, WanFang and VIP databases from the time the databases were established to November 2020. All analyses included in the studies comprised the subgroups of HPB and BA. The patency of AVF was compared between the two groups at 3 months, 6 months and 12 months after operation.ResultsNine studies comprising 475 patients were included in the meta-analysis. The pooled results revealed that stenosis rate of AVFs treated with HPB was significantly lower than that of AVFs treated with conventional balloon at 3 months (OR= 0.37, 95% CI 0.21 to 0.67, p<0.001) and 6 months after operation (OR= 0.33, 95% CI 0.15 to 0.75, p=0.008). In addition, the technical success rate of HPB groups was high (OR= 0.14, 95% CI 0.05 to 0.35, p<0.001). However, no significant difference was observed between the experimental and control groups at 12 months after operation (OR= 0.61, 95% CI 0.29 to 1.25, p=0.18). No significant publication bias was observed in the analyses.ConclusionHPB is a potential primary option for the treatment of AVF stenosis, with a lower 3- and 6-month stenosis rate than BA. However, the long-term effect of HPB was not satisfactory; therefore, further research should be conducted to elucidate the relationship between the two groups.