Drug-Eluting Stents for the Treatment of Arteriovenous Access Stenosis: A Systematic Review and Individual Patient
Vasiliki Manaki1, Vangelis Bontinis1, Argirios Giannopoulos1
1Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
Introduction:
The growing population of end-stage kidney disease (ESKD) patients on hemodialysis highlights the need to maintain durable vascular access, with stenosis being a common complication in both arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). While balloon angioplasty is suggested by the current guidelines, high restenosis rates have led to interest in alternatives. Drug-coated balloons (DCBs) and bare-metal stents (BMSs) offer limited patency, while stent-grafts lack long-term evidence. Drug-eluting stents (DESs), on the other hand, show promising results. This review aimed to assess the efficacy and safety of DESs for the treatment of arteriovenous (AV) access stenosis.
Materials And Methods:
A systematic search on PubMed, Scopus and Web of Science was performed. The primary end point was primary patency, while secondary end points included in-stent restenosis and juxta-stent restenosis. We reconstructed individual patient data (IPD) from the Kaplan-Meier curves of all eligible studies for the primary patency outcomes.
Results:
Six studies met the eligibility criteria, including 93 patients treated with drug-eluting stents (DES) for AV access stenosis. Among them, 70 had AVF stenosis, while 23 had AVG stenosis, with all studies utilizing the Eluvia polymer-coated low-dose paclitaxel DES (Boston Scientific, MA, US). A pooled IPD meta-analysis reconstructed Kaplan-Meier curves, estimating primary patency rates of 90.31% at 6 months, 77.95% at 12 months, and 77.85% at 18 months, with a mean primary patency duration of 20.1 months, signifying the period during which individuals remained event-free. Secondary outcomes showed pooled in-stent restenosis rates of 8.54% (95% CI: 1.74-18.42) and juxta-stent restenosis rates of 5.97% (95% CI: 0.03-17.38), both statistically significant.
Conclusion:
DESs application may be a safe and viable alternative for patients with AV access stenosis with encouraging primary patency outcomes. Long-term follow-up and high-quality randomized controlled trials will help clarify the issue.
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