Comparative Study of Plain Balloon versus Drug-coated Balloon for Angioplasty of Dysfunctional Autogenous Arteriovenous Fistula

Objectives: This study aimed to compare efficacy and safety of drug-coated balloon angioplasty (DCB) versus plain balloon angioplasty (PBA) in treating dysfunctional arteriovenous fistulas (AVFs) among end-stage renal disease (ESRD) patients. Primary endpoints were target lesion primary patency (TLPP) and secondary patency (TLSP), while secondary endpoints included adverse events and patency predictors. Patients and methods: A prospective comparative study was conducted over 1 year, including 30 patients with dysfunctional AVFs, divided into two groups: DCB (n=11) and PBA (n=19). Inclusion criteria involved mature AVFs with >50% stenosis and clinical dysfunction. Exclusion criteria included total thrombosis, infection, and contraindications to contrast media or paclitaxel. Results: At 6 months, TLPP was 72.7% for DCB and 78.9% for PBA (P 0.70), while at 1 year, TLPP was 63.6% for DCB and 55.6% for PBA (P 0.69). TLSP at 6 months was 90.9% for DCB and 89.5% for PBA (P 0.90), and at 1 year, it was 90.9% for DCB and 83.3% for PBA (P 0.57). Restenosis rates at 1 year were 36.4% for DCB and 42.1% for PBA (P 0.76). No significant predictors of TLPP were identified. Adverse events were minimal, one case of AVF rupture in PBA group and no procedure-related mortality. Conclusion: Both TLPP and TLSP were comparable in studied groups with no significant advantage of either group regarding safety or efficacy. While DCB may offer short-term benefits, more extended workup is needed to establish its long-term advantages over PBA in maintaining AVF health and functionality.