title: Paclitaxel-coated balloon angioplasty for symptomatic central vein restenosis in patients with hemodialysis fistulas.
abstract: OBJECTIVE
  To report a retrospective observational analysis of standard balloon angioplasty (BA) vs. paclitaxel-coated balloon angioplasty (PCBA) for symptomatic central vein restenoses in patients with impaired native hemodialysis fistulas.
  
  
  METHODS
  A retrospective review was conducted of 27 consecutive patients (15 men; mean age 66 ± 13.8 years, range 39-90) with 32 central vein stenoses (CVS; 6 axillary, 11 subclavian, 12 brachiocephalic, and/or 3 superior caval veins) treated successfully using BA. Freedom from reintervention after BA of de novo lesions was 7.4 ± 7.9 months (range 1-24). Twenty-five (92.6%) patients developed symptomatic restenoses and were treated one or more times by BA (n = 32) or PCBA (n = 20) using custom-made paclitaxel-coated balloons (diameter 6-14 mm).
  
  
  RESULTS
  Technical (< 30% residual stenosis) and clinical (functional fistula) success rates for the initial and secondary angioplasty procedures were 100%. No minor/major procedure-associated complications occurred. Mean follow-up was 18.4 ± 17.5 months. Kaplan-Meier analysis for freedom from target lesion revascularization (TLR) found PCBA superior to BA (p = 0.029). Median freedom from TLR after BA was 5 months; after PCBA, > 50% of patients were event-free during the observation period (mean freedom from TLR 10 months). Restenosis intervals were prolonged by PCBA (median 9 months) vs. BA (median 4 months; p = 0.023).
  
  
  CONCLUSIONS
  Paclitaxel-coated balloon angioplasty of central vein restenosis in patients with hemodialysis shunts yields a statistically significant longer freedom from TLR compared to standard balloon angioplasty.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany alexander.massmann@uks.eu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Massmann
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Fries
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Obst-Gleditsch
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Minko
authors.affiliation: Department of General, Abdominal, and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Roushanak
authors.initials: R
authors.lastname: Shayesteh-Kheslat
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Arno
authors.initials: A
authors.lastname: Buecker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods / Q000401:mortality; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel
keywords: arteriovenous fistula; central venous stenosis; drug-eluting balloon; endovascular intervention; hemodialysis; restenosis; target lesion revascularization; vein