Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, 500 University Avenue, Suite 602, Toronto, ON M5G1V7, Canada.
Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, 500 University Avenue, Suite 602, Toronto, ON M5G1V7, Canada.
J Vasc Interv Radiol. 2019 Apr;30(4):483-494.e1. doi: 10.1016/j.jvir.2019.01.012. Epub 2019 Mar 8.
To perform a systematic review and meta-analysis assessing patency outcomes following drug-coated balloon angioplasty (DCBA) in hemodialysis circuits.
MEDLINE and EMBASE systematic searches were performed from inception to November 2018 to identify comparative studies assessing DCBA vs plain old balloon angioplasty (POBA) in hemodialysis circuits. Abstract selection, data extraction, and quality assessment were performed by 2 independent reviewers. Primary outcome was loss of target lesion patency at 3, 6, 12, and 24 months for autogenous arteriovenous fistula (AVF), prosthetic arteriovenous graft (AVG), and hemodialysis-related central venous stenosis.
Twelve studies comprising 908 patients were included. There was a significant improvement in patency among AVF after DCBA vs POBA at 3, 6, 12, and 24 months (odds ratio 0.58 [95% confidence interval, 0.36-0.94]; odds ratio 0.40 [95% confidence interval 0.23-0.70]; odds ratio 0.39 [95% confidence interval, 0.25-0.61]; and odds ratio 0.20 [95% confidence interval, 0.07-0.62]). This benefit persisted on subgroup analysis of randomized controlled trials (RCTs) only. Meta-analysis of results specific to AVG could not be performed, as only 1 RCT was identified that favored DCBA. Hemodialysis-associated central vein stenosis did not demonstrate a significant difference in patency rates between DCBA and POBA on meta-analysis. Twelve-month mortality and same-day complication rates did not differ between arms.
Significant improvement in patency was identified with DCBA in AVF at 3, 6, 12, and 24 months. A single comparative study identified benefit of DCBA use in the AVG group. No significant benefit was identified with DCBA for central stenosis.
对药物涂层球囊血管成形术（DCBA）治疗血液透析通路后的通畅率进行系统评价和荟萃分析。
从建库至 2018 年 11 月，对 MEDLINE 和 EMBASE 进行了系统检索，以确定比较 DCBA 与普通球囊血管成形术（POBA）治疗血液透析通路的研究。由 2 名独立评审员进行摘要选择、数据提取和质量评估。主要结局为自体动静脉瘘（AVF）、人工动静脉移植物（AVG）和血液透析相关中心静脉狭窄 3、6、12 和 24 个月时的靶病变通畅率丧失。
共纳入 12 项研究，包括 908 例患者。与 POBA 相比，DCBA 治疗 AVF 后 3、6、12 和 24 个月的通畅率显著提高（比值比 0.58 [95%置信区间，0.36-0.94]；比值比 0.40 [95%置信区间，0.23-0.70]；比值比 0.39 [95%置信区间，0.25-0.61]；比值比 0.20 [95%置信区间，0.07-0.62]）。该获益在仅包含随机对照试验（RCT）的亚组分析中仍然存在。由于仅确定了一项有利于 DCBA 的 RCT，因此无法对 AVG 特定结果进行荟萃分析。荟萃分析显示，DCBA 和 POBA 治疗血液透析相关中心静脉狭窄的通畅率无显著差异。两组 12 个月死亡率和当天并发症发生率无差异。
DCBA 可显著提高 AVF 在 3、6、12 和 24 个月时的通畅率。一项比较研究发现 DCBA 对 AVG 组有益。DCBA 对中心狭窄无明显获益。
