title: Comparison of Cutting Balloon Angioplasty and Percutaneous Balloon Angioplasty of Arteriovenous Fistula Stenosis: A Meta-Analysis and Systematic Review of Randomized Clinical Trials.
abstract: BACKGROUND
  Hemodialysis (HD) access failure is a common cause of increased morbidity and healthcare cost in patients with end stage renal disease (ESRD). Percutaneous balloon angioplasty has been used to treat hemodialysis access stenosis but is complicated by a high rate of restenosis. Percutaneous cutting balloon (PCB) angioplasty is an alternative approach that has shown to reduce restenosis.
  
  
  OBJECTIVE
  The aim of the study is to assess the safety and efficacy of PCB angioplasty in comparison with conventional and high-pressure balloon angioplasty in the treatment of hemodialysis access site stenosis.
  
  
  METHODS
  We searched PubMed, EMBASE and the Cochrane Central register of controlled trials (CENTRAL) databases through August 2014 and selected studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We included all randomized clinical trials with a head-to-head comparison between PCB and conventional or high-pressure balloon angioplasty
  
  
  RESULTS
  Three studies with 1034 participants (age 60.7 (±12.9) years and 50.1% males) with 525 in PCB and 509 in control arm were included in the analysis. The immediate procedural success rate was not significantly different in the PCB angioplasty and control arm respectively, (87.2% vs. 83.7% RD -0.02; 95%CI -0.06 to 0.01; P = 0.38). The six-month target lesion patency was significantly higher in the PCB angioplasty arm (67.2% vs. 55.6% RD 0.12; 95%CI 0.05-0.19; P < 0.05) with number needed to treat (NNT) of 9. The device related complications were not statistically significant between groups (RD 0.03; 95%CI -0.02 to 0.07; P = 0.26).
  
  
  CONCLUSIONS
  PCB angioplasty is effective in treatment of hemodialysis access stenosis, with significantly higher six-month patency compared to balloon angioplasty.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Arkansas Medical Sciences, Little Rock, Arkansas.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
authors.affiliation: Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rabi
authors.initials: R
authors.lastname: Yacoub
authors.affiliation: Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: James S
authors.initials: JS
authors.lastname: Jenkins
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Tyrone J
authors.initials: TJ
authors.lastname: Collins
authors.affiliation: Department of Medicine, Division of Rheumatology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Narender
authors.initials: N
authors.lastname: Annapureddy
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Damodar
authors.initials: D
authors.lastname: Kumbala
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Shirisha
authors.initials: S
authors.lastname: Bodana
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Benjo
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical; D003251:Constriction, Pathologic / Q000628:therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D014654:Vascular Patency