Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. May-Jun 2018;19(3):410-416.
doi: 10.3348/kjr.2018.19.3.410. Epub 2018 Apr 6.

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

Affiliations
Free PMC article

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

Keerati Hongsakul et al. Korean J Radiol. .
Free PMC article

Abstract

Objective: To report the results of angioplasty with paclitaxel-coated balloons for the treatment of early restenosis of central veins in hemodialysis patients.

Materials and methods: Sixteen patients (9 men and 7 women; mean age 65.8 ± 14.4 years; range, 40-82 years) with 16 episodes of early restenoses of central veins within 3 months (median patency duration 2.5 months) were enrolled from January 2014 to June 2015. Ten native central veins and 6 intra-stent central veins were treated with double paclitaxel-coated balloons (diameter 6-7 mm) plus a high pressure balloon (diameter 12-14 mm). The study outcomes included procedural success (< 30% residual stenosis) and primary patency of the treated lesion (< 50% angiographic stenosis without re-intervention).

Results: Procedural success was achieved in all 16 cases of central vein stenoses. The mean diameter of the central vein was 3.7 ± 2.4 mm before the procedure vs. 11.4 ± 1.8 mm after the initial procedure. There were no procedure-related complications. The mean diameters of the central veins at 6 months and 12 months were 7.8 ± 1.3 mm and 6.9 ± 2.7 mm, respectively. The primary patency rates at 6 months and 12 months were 93.8% and 31.2%, respectively. One patient had significant restenosis of the central vein at 3 months. The median primary patency period was 9 months for paclitaxel-coated balloons and 2.5 months for the last previous procedure with conventional balloons (p < 0.001).

Conclusion: In our limited study, paclitaxel-coated balloons seem to improve the patency rate in cases of early restenosis of central veins. However, a further randomized control trial is necessary.

Keywords: Angioplasty; Central vein; Paclitaxel-coated balloon; Patency; Stenosis.

Figures

Fig. 1
Fig. 1. Angioplasty technique
A. First, double paclitaxel-coated balloon (each 6-7 mm in diameter) angioplasty was performed. B. Second, high pressure balloon (12-14 mm) angioplasty was performed.
Fig. 2
Fig. 2. Kaplan-Meier curve for primary patency at 3, 6, 9, and 12 months after procedure
Fig. 3
Fig. 3. 55-year-old patient with early recurrent significant stenosis of left brachiocephalic vein
A. Initial angiography shows significant stenosis of left brachiocephalic vein (arrow). B. Immediate angiography after procedure shows no stenosis of left brachiocephalic vein. C. Angiography at 6 months shows no recurrent stenosis (arrow). D. Angiography at 12 months shows no significant stenosis (arrow).
Fig. 4
Fig. 4. 65-year-old patient with early recurrent significant stenosis of left subclavian vein
A. Initial angiography shows severe stenosis of left subclavian vein (arrow). B. Immediate angiography after procedure shows no stenosis of left subclavian vein. C. Angiography at 3 months shows significant restenosis of left subclavian vein (arrow).
Fig. 5
Fig. 5. Kaplan-Meier curve comparing primary patency between historical data after last PBA and PCBA in same patients
Median patency times for PBA and PCBA were 2.5 months and 9 months, respectively (p < 0.001). PBA = plain balloon angioplasty, PCBA = paclitaxel-coated balloon angioplasty

Similar articles

See all similar articles

Cited by 2 articles

References

    1. Massmann A, Fries P, Obst-Gleditsch K, Minko P, Shayesteh-Kheslat R, Buecker A. Paclitaxel-coated balloon angioplasty for symptomatic central vein restenosis in patients with hemodialysis fistulas. J Endovasc Ther. 2015;22:74–79. - PubMed
    1. Hongsakul K, Rookkapan S, Sungsiri J, Boonsrirat U, Kritpracha B. Pharmacomechanical thrombolysis versus surgical thrombectomy for the treatment of thrombosed haemodialysis grafts. Ann Acad Med Singapore. 2015;44:66–70. - PubMed
    1. Boonsrirat U, Hongsakul K. Pharmacomechanical thrombolysis for the treatment of thrombosed native arteriovenous fistula: a single-center experience. Pol J Radiol. 2014;79:363–367. - PMC - PubMed
    1. Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg. 2007;45:776–783. - PubMed
    1. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(Suppl 1):S176–S247. - PubMed

Substances

Feedback