Evaluating Intervention Rates for Dysfunctional Arteriovenous Fistulas: Post-hoc Analysis of the IN.PACT AV Access...

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• Kidney Disease Outcomes Quality Initiative (KDOQI) 2019 guidelines recommend ≤3 interventions/year for arteriovenous fistula (AVF) patency.
• Drug-coated balloons (DCB) may offer improved outcomes over standard percutaneous transluminal angioplasty (PTA) for AVF maintenance.

Purpose of the Study:

• To evaluate if interventions for AVF patency in a clinical trial align with KDOQI targets.
• To compare the efficacy of DCB versus PTA in reducing thrombosis and reintervention rates for AVF maintenance.

Main Methods:

• Post-hoc analysis of the IN.PACT AV Access randomized clinical trial.
• Adult hemodialysis patients with AVFs and de novo or re-stenotic lesions were randomized to DCB or PTA.
• Intervention rates and thrombosis rates were calculated and compared to KDOQI 2019 targets over 36 months.

Main Results:

• Both DCB and PTA groups achieved KDOQI targets (≤3 interventions/year).
• The DCB group required fewer interventions for patency (1.39/AVF-year) versus PTA (1.66/AVF-year) (P=0.01).
• Access circuit thrombosis rates were lower in the DCB group (0.041) compared to PTA (0.069), though not statistically significant (P=0.1).

Conclusions:

• Both DCB and PTA effectively maintain AVF patency within KDOQI guidelines.
• DCB demonstrated a significant reduction in reinterventions and a trend towards lower thrombosis rates compared to PTA over 36 months.