Network meta-analysis of trials comparing first line endovascular treatments for arteriovenous fistula stenosis

J Vasc Surg. 2021 Jun;73(6):2198-2203.e3. doi: 10.1016/j.jvs.2020.12.080. Epub 2020 Dec 29.

Abstract

Objective: We investigated the comparative effectiveness of different endovascular treatments for patients with failing autogenous arteriovenous fistulas (AVFs) with outflow vein stenosis.

Methods: The Medline (via PubMed) and SCOPUS databases were searched. We performed a systematic review and network meta-analysis of randomized controlled trials that had investigated the effectiveness of plain balloon angioplasty (PBA), cutting balloon angioplasty, and drug-coated balloon angioplasty (DCBA) to treat vein stenoses in autogenous AVFs. Studies of central vein stenosis were excluded. The main outcome measures were the failure rates at 6 months and 1 year after treatment.

Results: Eleven randomized controlled trials were included, with 814 patients, 395 of whom had undergone PBA. The network meta-analysis showed that DCBA at 6 months was significantly more effective than PBA (odds ratio, 0.39; 95% confidence interval, 0.18-0.81) and ranked as the best treatment option, although the difference was not statistically significant compared with cutting balloon angioplasty (odds ratio, 0.65; 95% confidence interval, 0.20-2.12). The differences among the three treatments at 1 year were not statistically significant. Additional conventional pairwise meta-analyses did not find significant differences at 1 year.

Conclusions: In failing AVFs with outflow stenosis, DCBA was significantly superior to PBA, with improved 6-month failure rates. However the effectiveness of DCBA in the long term deserves further investigation.

Keywords: Arteriovenous fistula; Balloon angioplasty; Cutting balloon; Drug-coated balloon; Meta-analysis; Stenosis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Angioplasty, Balloon* / adverse effects
  • Angioplasty, Balloon* / instrumentation
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Coated Materials, Biocompatible
  • Equipment Design
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Network Meta-Analysis
  • Randomized Controlled Trials as Topic
  • Renal Dialysis
  • Time Factors
  • Treatment Outcome
  • Vascular Access Devices
  • Vascular Patency

Substances

  • Coated Materials, Biocompatible