Fixing Failing Fistulas

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SEATTLE—Use of the ultrahigh-pressure (UHP) balloon immediately after percutaneous transluminal angioplasty (PTA) is equivalent to the peripheral cutting balloon (PCB) for treating venous stenosis in patients with dialysis fistulas, preliminary findings suggest.

 

Researchers evaluated the immediate effect of UHP balloons and PCB in 22 patients (19 men) with failing fistulas in a randomized, control trial.

 

The researchers used the AngioFlow device to measure fistula blood flow. All patients had blood flow less than 500 mL/min. There were 12 patients in the UHP group and 10 patients in the PCB group. The patients had a mean age of 69 years (range: 42 to 88 years).

 

A total of 35 PTAs were performed, 15 in the PCB group and 20 in the UHP group. The technical success rate was 100%, with no major complications.

 

The UHP and PCB groups had a pre-intervention mean blood flow of 288 and 391 mL/min, respectively. After the procedure, it was 613 and 606 mL/min, respectively.

Post-intervention showed a mean increase in flow of 325.8 mL/min in the UHP group and 213 mL/min in the PCB group. Researchers reported findings here at the Society of Interventional Radiology annual meeting.

 

“This is the first study of its kind,” said lead investigator Sanjoy Kundu, MD, an interventional radiologist at Scarborough General Hospital in Scarborough, Ontario. “We found no statistical difference in the immediate effect of ultrahigh-pressure versus the peripheral-cutting balloon, and this has significant cost ramifications. The peripheral cutting balloon is about three times the cost of the ultrahigh-pressure balloon. As a first-line device, I don't think that based on this study we can say you should use the peripheral cutting balloon.”

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