Comparison of Clinical Efficacy and Safety of Drug-Coated Balloons versus Percutaneous Transluminal Angioplasty in Arteriovenous Fistulas: A Review of Systematic Reviews and Updated Meta-Analysis.

PURPOSE: A review of systematic reviews (SRs) and an update of the current meta-analysis were conducted to evaluate the clinical efficacy and safety of drug-coated balloons (DCBs) compared with percutaneous transluminal angioplasty (PTA) for arteriovenous fistula (AVF) stenosis.

MATERIALS AND METHODS: Literature was searched to retrieve SRs comparing DCBs and PTA for AVFs. A narrative review of SRs and pooled analysis were performed.

RESULTS: Eleven SRs were included. DCBs demonstrated favorable outcomes at 6 and 12 months compared with PTA, with improved patency in seven SRs and a trend toward favorable outcomes without statistical significance in three SRs. TLR was reported in three SRs; two reviews reported a significantly lower incidence in the DCB group than in the PTA group, whereas one review reported no significant differences at 12 months. Four studies reporting all-cause mortality revealed no significant difference between the two treatments. In the updated meta-analysis including 23 studies, DCBs demonstrated improved primary patency at 6 and 12 months (RR, 1.27; 95% confidence interval [CI], 1.07-1.50 and RR, 1.36; 95% CI, 1.19-1.55, respectively) and was associated with a lower incidence of TLR at 6 and 12 months (RR, 0.54; 95% CI, 0.41-0.73 and RR, 0.78; 95% CI, 0.62-0.99, respectively). There was no difference in mortality between the two groups for 24 months.

CONCLUSION: A review of SRs and meta-analysis update revealed the consistent benefits of DCBs over PTA in treating AVFs in terms of primary patency and TLR. Compared with PTA, DCBs do not increase mortality risk.