Angioplasty of long venous stenoses in hemodialysis access: at last an indication for cutting balloon?
OBJECTIVE
To compare the postintervention primary patency rates of cutting balloon angioplasty (CBA) with those of conventional percutaneous transluminal angioplasty (PTA) in the treatment of hemodialysis-related stenoses at least 2 cm long.


METHODS
This retrospective and controlled study included 29 patients with a hemodialysis-related stenosis at least 2 cm long. From August 2002 to August 2003, nine patients (PTA group, six upper-arm and three forearm fistulas) were treated with a conventional balloon (5-8 mm, 4 cm long). From September 2003 to December 2005, 20 patients (CBA group, 12 upper-arm and seven forearm fistulas; one polytetrafluoroethylene hemodialysis graft) were treated with a cutting balloon (5-7 mm, 1 cm long). The median follow-up was 22.1 months for the CBA group and 15.6 months for the PTA group. The Kaplan-Meier method was used to calculate the primary cumulative patency rates, and the log-rank test was used for comparison. Multivariate Cox models were generated by combining three variables: patient age, stenosis length, and treatment type (CBA or PTA).


RESULTS
In the CBA group, the postintervention primary patency was 85% +/- 16 at 6 months, 70% +/- 20 at 1 year, and 32% +/- 26 at 18 months. In the PTA group, the postintervention primary patency was 56% +/- 32 at 6 months and 21% (range, 0%-53%) at 1 year. When comparing PTA versus CBA with the log-rank test, there was a statistically significant difference (P = .009). With the multivariate Cox models, treatment was again a statistically significant (P = .007) determinant of primary patency; patient age and stenosis length were not.


CONCLUSIONS
The use of a cutting balloon as the first-line treatment for stenoses at least 2 cm long significantly improves the postintervention primary patency rate.
Department of Interventional Radiology, CHU le Bocage, University Hospital of Dijon, Boulevard Maréchal de Lattre de Tassigny, 21000 Dijon, France. boris.guiu@chu-dijon.fr
Boris
B
Guiu
Romaric
R
Loffroy
Douraied
D
Ben Salem
Jean-Pierre
JP
Cercueil
Serge
S
Aho
Christiane
C
Mousson
Denis
D
Krausé
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000800:Angioplasty, Balloon; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical; D003251:Constriction, Pathologic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012107:Research Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000601:surgery