Recurrent Stenoses in Arteriovenous Fistula (AVF) for Dialysis Access: cuttIng ballooN angioplaSTy combined wITh paclitaxel drUg-coaTed balloon angioplasty, an observatIONal study/ (INSTITUTION Study)
Tan et al. Cardiovasc Intervent Radiol https://doi.org/10.1007/s00270-021-03030-w
To compare safety and efficacy of cutting balloon angioplasty (CBA) followed by paclitaxel drug-coated balloon (PCB) angioplasty for recurrent venous lesions in arteriovenous fistulas (AVFs). Combining CBA (lower inflation pressures) and PCB (decrease in HIH) might synergistically improve primary patency.
AVF dysfunction determined by Kt/V and physical exam. Clinical issues of cannulation, bleeding , and excessive flow or venous pressure are poorly defined as 600 ml/min access flow is quite acceptable and a VP of 150 without blood pump flow is relatively meaningless. They did have access to Transonic flow technology. Out of a total of 42 AVF, 33 were RC, 5 BC, and 4BB. Median AVF access age was 2.68 yrs. M mean interval since prior intervention rangewas 62–362, with median of 193 days.
Target lesions were included if they had recurred within 12 months post-angioplasty, were[ = 0.5 cm upstream from the arteriovenous anastomosis and did not involve the central veins. Target lesios were 28 Juxta -anastomotic, 9 cannulation segment, and distal outflow. Elastic recoils after angio was significant at 21-45%. Non target lesions were present in 18-42 cases (20 lesions in total). F/U for 12 months was available for 36 of the pats (4 pts died in interim)
Median follow-up duration was 337.5 days. target lesion primary, primary assisted and circuit patency for the entire study population (n = 42) were 61.6 ± 7.8%, 92.7 ± 4.0%, and 54.7 ± 7.9%, respectively, at 12 months. For participants without non-target lesions (n = 22), the rates were 77.3 ± 8.9%, 90.9 ± 6.1%, and60.7 ± 11.0%, respectively, at 12 months.
There is no comparison group. Discussion focuses on 3 references from literature in which PCB were “ superior “ to conventional balloons. Limitations include small sample size and non treatment of secondary significant lesions. Cost may be significant issue to adoption.
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Percutaneous Arteriovenous Fistula Creation with the WavelinQ 4-French EndoAVF System: A Single-Center Retrospective Analysis of 30 Patients
Panagiotis M. Kitrou, MD, Lamprini Balta, MD,Evangelos Papachristou, MD, PhD, Marios Papasotiriou, MD, PhD et al
J Vasc Interv Radiol 2022; 33:33–40 https://doi.org/10.1016/j.jvir.2021.09.021

Half of the 30 AVF so created required reintervention to permit adequate cannulation & more Interventions for maintenance. Assisted Patency was 96% at 1 yr’ , 82 % at 2 and 3 yrs. The
criteria for a pAVF to be considered ready for cannulation were a flow volume of ≥500 mL/min in the brachial artery and a ≥5-mm diameter of the vein for cannulation. 21/30 pAVF were RC.
As discussed at the ASDIN mtg, we need more data to determine what the role will be of pAVFs.
Unfortunately, anatomical factors and underlying vascular disease precluded a direct RCT.