Cutting balloon angioplasty in the treatment of failing arterio-venous fistula: efficacy and outcomes

BACKGROUND: The cutting balloon has been noted for causing less Neo-intimal Hyperplasia through controlled cuts at low pressure, resulting in reduced vascular injury and restenosis. The aim is to assess the outcomes, safety, and effectiveness of endovascular repair for failing arteriovenous fistula (AVF) in chronic renal failure patients, using cutting balloon angioplasty as the primary treatment. METHODS: A retrospective study conducted in Saudi German Hospitals between 2020 and 2022 with 3, 6, and 12-month follow-ups through clinical assessments and duplex scans. Thirty-seven patients undergoing regular hemodialysis for chronic renal failure with a failing AVF underwent endovascular repair using peripheral cutting balloon angioplasty. Balloon catheters of varying sizes were used based on the type and location of lesions. Primary outcomes included technical success and primary patency, while secondary outcomes encompassed secondary patency rates, complication rates, and clinical success. RESULTS: The study comprised 37 patients, with a majority being male (62%), and a mean age of 52 years (range: 35-67). Common co-morbidities included hypertension (94.5%), diabetes (54%), smoking (40.5%), and cardiovascular diseases (40.5%). The most prevalent AVF types were Brachio-cephalic (45.9%), Radio-cephalic (29.7%), and Superficialized Brachio-basilic (24.3%). Trans radial access was utilized in 91.8% of patients. The most frequent stenotic lesions were venous juxta-anastomotic (48.6%) and puncture site lesions (21.6%). Technical success was achieved in 91.8% of cases. The primary patency rate at six months was 85.3%, and at one year, it decreased to 61%. Secondary patency rates at six and twelve months were 94.1% and 79.4%, respectively. CONCLUSIONS: Peripheral cutting balloon angioplasty proved to be a safe and effective primary treatment for failing AVF, with a low complication rate and high patency rates.