A multicenter randomized controlled trial indicates that paclitaxel-coated balloons provide no benefit for arteriovenous fistulas

Abstract

The role of paclitaxel-coated balloons has been established in the coronary and peripheral arterial circulations with recent interest in the use of paclitaxel-coated balloons to improve patency rates following angioplasty of arteriovenous fistulas. To assess the efficacy of paclitaxel-coated angioplasty balloons to prolong the survival time of target lesion primary patency in arteriovenous fistulas, we designed an investigator-led multi-center randomized controlled trial with follow up time variable for a minimum of one year. Patients with an arteriovenous fistula who were undergoing an angioplasty for a clinical indication were included but patients with one or more lesions outside the treatment segment were excluded. Following successful treatment with a high-pressure balloon, 212 patients were randomized. In the intervention arm, the second component was insertion of a paclitaxel-coated balloon. In the control arm, an identical procedure was followed, but using a standard balloon. The primary endpoint was time to loss of clinically driven target lesion primary patency. Primary analysis showed no significant evidence for a difference in time to end of target lesion primary patency between groups: hazard ratio 1.18 with a 95% confidence interval of 0.78 to 1.79. There were no significant differences for any secondary outcomes, including patency outcomes and adverse events. Thus, our study demonstrated no evidence that paclitaxel-coated balloons provide benefit, following standard care high-pressure balloon angioplasty, in the treatment of arteriovenous fistulas. Hence, in view of the benefit suggested by other trials, the role of paclitaxel-coated angioplasty balloons remains uncertain. The role of paclitaxel-coated balloons has been established in the coronary and peripheral arterial circulations with recent interest in the use of paclitaxel-coated balloons to improve patency rates following angioplasty of arteriovenous fistulas. To assess the efficacy of paclitaxel-coated angioplasty balloons to prolong the survival time of target lesion primary patency in arteriovenous fistulas, we designed an investigator-led multi-center randomized controlled trial with follow up time variable for a minimum of one year. Patients with an arteriovenous fistula who were undergoing an angioplasty for a clinical indication were included but patients with one or more lesions outside the treatment segment were excluded. Following successful treatment with a high-pressure balloon, 212 patients were randomized. In the intervention arm, the second component was insertion of a paclitaxel-coated balloon. In the control arm, an identical procedure was followed, but using a standard balloon. The primary endpoint was time to loss of clinically driven target lesion primary patency. Primary analysis showed no significant evidence for a difference in time to end of target lesion primary patency between groups: hazard ratio 1.18 with a 95% confidence interval of 0.78 to 1.79. There were no significant differences for any secondary outcomes, including patency outcomes and adverse events. Thus, our study demonstrated no evidence that paclitaxel-coated balloons provide benefit, following standard care high-pressure balloon angioplasty, in the treatment of arteriovenous fistulas. Hence, in view of the benefit suggested by other trials, the role of paclitaxel-coated angioplasty balloons remains uncertain. Complications of vascular access are an important cause of morbidity and mortality in hemodialysis patients.1Roy-Chaudhury P. Sukhatme V.P. Cheung A.K. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint.J Am Soc Nephrol. 2006; 17: 1112-1127Crossref PubMed Scopus (408) Google Scholar It is widely accepted that an arteriovenous fistula (AVF) is the optimal form of vascular access, with better patency and lower infection rates than arteriovenous grafts and central venous catheters.2Pisoni R.L. Young E.W. Dykstra D.M. et al.Vascular access use in Europe and the United States: results from the DOPPS.Kidney Int. 2002; 61: 305-316Abstract Full Text Full Text PDF PubMed Scopus (699) Google Scholar The initial therapy for a stenosis in an AVF is balloon angioplasty with high pressure, as needed.3Lok C.E. Huber T.S. Lee T. et al.Kdoqi clinical practice guideline for vascular access: 2019 update.Am J Kidney Dis. 2020; 75: S1-S164Abstract Full Text Full Text PDF PubMed Scopus (310) Google Scholar A major concern, however, is the longevity of this effect. Retrospective studies have reported postintervention primary patency rates of around 60% to 70% at 6 months and 40% to 50% at 1 year.4Rajan D.K. Bunston S. Misra S. et al.Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty--are there clinical predictors of patency?.Radiology. 2004; 232: 508-515Crossref PubMed Scopus (141) Google Scholar, 5Manninen H.I. Kaukanen E.T. Ikaheimo R. et al.Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas--initial success and long-term results.Radiology. 2001; 218: 711-718Crossref PubMed Scopus (113) Google Scholar, 6Heye S. Maleux G. Vaninbroukx J. et al.Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas.Eur J Radiol. 2012; 81: 2298-2303Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 7Manou-Stathopoulou S. Robinson E.J. Harvey J.J. et al.Factors associated with outcome after successful radiological intervention in arteriovenous fistulas: a retrospective cohort.J Vasc Access. 2019; 20: 716-724Crossref PubMed Scopus (7) Google Scholar, 8Aktas A. Bozkurt A. Aktas B. Kirbas I. Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency.Diagn Interv Radiol. 2015; 21: 160-166Crossref PubMed Scopus (26) Google Scholar, 9Turmel-Rodrigues L. Pengloan J. Baudin S. et al.Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology.Nephrol Dial Transplant. 2000; 15: 2029-2036Crossref PubMed Scopus (289) Google Scholar, 10Bountouris I. Kristmundsson T. Dias N. et al.Is repeat PTA of a failing hemodialysis fistula durable?.Int J Vasc Med. 2014; 2014: 369687PubMed Google Scholar Hence, more durable interventions are required to reduce restenosis rates. There has been recent interest in the use of paclitaxel-coated balloons to improve patency rates following angioplasty of AVFs. The role of paclitaxel-coated balloons has been established in the coronary and peripheral arterial circulations.11Katsanos K. Spiliopoulos S. Karunanithy N. et al.Bayesian network meta-analysis of nitinol stents, covered stents, drug-eluting stents, and drug-coated balloons in the femoropopliteal artery.J Vasc Surg. 2014; 59: 1123-1133.e1128Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar,12Siontis G.C. Stefanini G.G. Mavridis D. et al.Percutaneous coronary interventional strategies for treatment of in-stent restenosis: a network meta-analysis.Lancet. 2015; 386: 655-664Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar A number of small studies have explored the potential in AVFs.13Kitrou P.M. Papadimatos P. Spiliopoulos S. et al.Paclitaxel-coated balloons for the treatment of symptomatic central venous stenosis in dialysis access: results from a randomized controlled trial.J Vasc Interv Radiol. 2017; 28: 811-817Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 14Maleux G. Mijnsbrugge W.V. Henroteaux D. et al.Multicenter, randomized trial of conventional balloon angioplasty versus paclitaxel-coated balloon angioplasty for the treatment of dysfunctioning autologous dialysis fistulae.J Vasc Interv Radiol. 2018; 29: 470-475Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 15Lai C.C. Fang H.C. Tseng C.J. et al.Percutaneous angioplasty using a paclitaxel-coated balloon improves target lesion restenosis on inflow lesions of autogenous radiocephalic fistulas: a pilot study.J Vasc Interv Radiol. 2014; 25: 535-541Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 16Katsanos K. Karnabatidis D. Kitrou P. et al.Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial.J Endovasc Ther. 2012; 19: 263-272Crossref PubMed Scopus (125) Google Scholar, 17Kitrou P.M. Katsanos K. Spiliopoulos S. et al.Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472).Eur J Radiol. 2015; 84: 418-423Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar These included studies with arteriovenous grafts in addition to AVFs16Katsanos K. Karnabatidis D. Kitrou P. et al.Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial.J Endovasc Ther. 2012; 19: 263-272Crossref PubMed Scopus (125) Google Scholar,17Kitrou P.M. Katsanos K. Spiliopoulos S. et al.Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472).Eur J Radiol. 2015; 84: 418-423Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar and a study in central venous stenosis.13Kitrou P.M. Papadimatos P. Spiliopoulos S. et al.Paclitaxel-coated balloons for the treatment of symptomatic central venous stenosis in dialysis access: results from a randomized controlled trial.J Vasc Interv Radiol. 2017; 28: 811-817Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Two larger randomized controlled trials in AVFs have been performed. One of these included 148 lesions and an than clinical primary T. et of balloon for hemodialysis stenosis after one to high-pressure a randomized Radiol. 2020; PubMed Scopus Google Scholar The other randomized lesions and an J.J. K. L. et control trial of drug-eluting balloon in native dialysis fistula Vasc Access. 2019; 20: PubMed Scopus Google Scholar In this second of lesions an endovascular of the In of these lesion was included in the trial in that the were Two randomized controlled trials have been and these provide the evidence to The by et patients with AVFs from J. P. balloon angioplasty in failing fistulas: a randomized controlled J Am Soc Nephrol. 2018; PubMed Scopus Google P. et randomized trial of paclitaxel-coated balloons in arteriovenous fistula results and Vasc Interv Radiol. 2020; Full Text Full Text PDF PubMed Scopus Google Scholar There was no evidence that paclitaxel-coated angioplasty was more at the primary end patency survival at with conventional A second by et patients from K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar The results showed that the primary endpoint of target lesion primary patency at 6 months was in with paclitaxel-coated balloons vs. The balloon of stenosis in access trial is the randomized controlled trial designed to the efficacy of paclitaxel-coated balloons in AVFs. a randomized controlled trial and to patients with a clinical indication for angioplasty of an from patients were randomized to of a second balloon, was or standard by the using a was to the interventional the procedure and radiological intervention and on hemodialysis at study The was from the for to interventional and the including trial The to treatment of the of the paclitaxel-coated balloon. the access or stents, outside the treatment central or stenosis after high-pressure balloon the was N. A. et al.Paclitaxel-coated balloon versus plain balloon to the patency of arteriovenous for haemodialysis study for a controlled 17: PubMed Scopus Google Scholar in and the to in patients who hemodialysis and patients with a treatment segment lesions that with a drug-coated balloon up to in These were to the for an of lesions outside the treatment was a of the A of to and is in with trial in Full of and are in the and final Patients were up for a minimum of 1 and patients in the study the 1 of patients and the trial was by the Following the the the the treatment the procedure was with a high-pressure balloon with up to to of the lesion to the study Following and were In the intervention arm, the second component was insertion of a paclitaxel-coated balloon and in the control arm, an identical procedure was followed, but using a standard balloon The primary endpoint was time to loss of was as patency with no to the and to the treatment any of the following clinically driven to the treatment that the treatment intervention that the treatment segment from the access or of the AVF to an to the treatment To a interventional to the one who the procedure patency were time to loss of access primary patency and time to loss of access patency. primary patency any of the following access an intervention radiological or in the access or the access is to an to any patency the AVF is of radiological or with or a thrombosis for that patency were with patency. secondary were as loss of restenosis success at number of thrombosis fistula adverse and of using and at 6 and months on the primary and secondary endpoint are in the and final secondary endpoint analysis was by the The and have been in the N. A. et al.Paclitaxel-coated balloon versus plain balloon to the patency of arteriovenous for haemodialysis study for a controlled 17: PubMed Scopus Google Scholar and in the analysis was To the of the paclitaxel-coated balloon with the standard balloon in time to loss of was with treatment and the factors as The interventional the study was for as this of was by to Patients were survival at the end of or a to or from the primary the study were to the was and an between treatment and was to for variable time was of patients with study treatment or to were or treatment secondary and an analysis of the primary outcome to the of on the treatment and an analysis using to primary and as than to the of the from the primary endpoint the the time on of native fistula the one with was intervention to the access and of stenosis the and after but the were of to secondary outcomes were using the outcomes for the as as of the outcomes for were using with time in trial as the are reported as hazard or with 95% confidence survival were by treatment to the time to loss of the patency were for this access or and a of was to treatment patients reported at one was using and 212 patients from were randomized the trial paclitaxel-coated balloon and standard The trial on patients at 1 of and are reported in 1 and and therapy and of The of patients in the paclitaxel-coated and standard balloon who were and and and or coronary and the hemodialysis in the United as the and we included patients who the and were In and of the fistula been In the the intervention was to fistula or use for There was a of for intervention that are in with clinical including fistula and lesion between the A high-pressure balloon is in the There were no differences in of use or in the of the high-pressure and treatment balloons Two patients treatment were after but were included in the analysis by in The time of the treatment balloon was as in the in and of in the paclitaxel-coated and standard balloon There were no other major patients from and were in the primary no patients were to was and treatment of the balloon balloon vascular on of fistula of native fistula been at fistula was at access a interventions to the access radiological intervention in access of the to indication for the venous arterial balloon as balloon balloon balloon time of of are as at the in a are as 1 a interim analysis was the number of primary endpoint and was The and results and the of the trial as the and efficacy been the end of the patients the primary loss of the trial with in treatment in the paclitaxel-coated balloon and in the standard balloon and who the to were at and There was no evidence of a difference in time to loss of in the paclitaxel-coated balloon with the standard balloon using 95% and there was no that variable time to The results were in the secondary including or in the analysis patients randomized in the trial were included in the final survival and no patients were to there were no primary outcome and of the primary and secondary outcome balloon balloon treatment difference to loss of target lesion primary 1.18 to loss of access primary to loss of access who required an intervention 6 to intervention were in the paclitaxel-coated balloon and in the standard balloon restenosis who required an intervention 6 to intervention were in the paclitaxel-coated balloon and in the standard balloon of thrombosis of fistula of adverse at 6 at at 6 at confidence hazard outcome are as who required an intervention 6 to intervention were in the paclitaxel-coated balloon and in the standard balloon in a confidence hazard outcome are as 6 the was of in the paclitaxel-coated balloon with of in the standard balloon these were of and of was the for the primary endpoint in and of the paclitaxel-coated and standard balloon In of of was the primary endpoint of by the interventional who the was treatment paclitaxel-coated and standard the primary endpoint was thrombosis and intervention and 1 or a to the fistula and of paclitaxel-coated and standard balloon fistulas that been for of these were the end of access the time to secondary outcomes of loss of access primary and there was no evidence for a difference between the treatment and and and of the other secondary outcomes demonstrated a treatment of paclitaxel-coated balloon with standard balloon loss was and restenosis at 6 months in and and success stenosis after treatment with paclitaxel-coated or standard in and for the number of thrombosis fistula adverse and of at 6 and months are in and were in on of at 6 and months are in with a of adverse in were and the for reported adverse a at one for In were reported the study paclitaxel-coated balloon vs. standard including vs. and vs. The of the trial was to assess the efficacy of paclitaxel-coated balloons in the treatment of AVFs to a number of studies have suggested a P.M. Papadimatos P. Spiliopoulos S. et al.Paclitaxel-coated balloons for the treatment of symptomatic central venous stenosis in dialysis access: results from a randomized controlled trial.J Vasc Interv Radiol. 2017; 28: 811-817Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 14Maleux G. Mijnsbrugge W.V. Henroteaux D. et al.Multicenter, randomized trial of conventional balloon angioplasty versus paclitaxel-coated balloon angioplasty for the treatment of dysfunctioning autologous dialysis fistulae.J Vasc Interv Radiol. 2018; 29: 470-475Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 15Lai C.C. Fang H.C. Tseng C.J. et al.Percutaneous angioplasty using a paclitaxel-coated balloon improves target lesion restenosis on inflow lesions of autogenous radiocephalic fistulas: a pilot study.J Vasc Interv Radiol. 2014; 25: 535-541Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 16Katsanos K. Karnabatidis D. Kitrou P. et al.Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial.J Endovasc Ther. 2012; 19: 263-272Crossref PubMed Scopus (125) Google Scholar, 17Kitrou P.M. Katsanos K. Spiliopoulos S. et al.Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472).Eur J Radiol. 2015; 84: 418-423Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, T. et of balloon for hemodialysis stenosis after one to high-pressure a randomized Radiol. 2020; PubMed Scopus Google Scholar, J.J. K. L. et control trial of drug-eluting balloon in native dialysis fistula Vasc Access. 2019; 20: PubMed Scopus Google Scholar there are randomized trials, with clinical this J. P. balloon angioplasty in failing fistulas: a randomized controlled J Am Soc Nephrol. 2018; PubMed Scopus Google K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar The trial by et using the paclitaxel-coated balloon as the to a difference between in primary at J. P. balloon angioplasty in failing fistulas: a randomized controlled J Am Soc Nephrol. 2018; PubMed Scopus Google Scholar but there was a significant difference at in an A from this study showed a significant difference at and months but at or P. et randomized trial of paclitaxel-coated balloons in arteriovenous fistula results and Vasc Interv Radiol. 2020; Full Text Full Text PDF PubMed Scopus Google Scholar the efficacy of paclitaxel-coated balloons for this A recent study by et that a primary endpoint of at 6 months evidence of a benefit for paclitaxel-coated K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar One for the in this and the study is the use of a treatment balloon. The balloon in the study a of and with a of In the balloon by et is with a of and a These were in a angioplasty K. et of after treatment with versus paclitaxel-coated balloons in Vasc Interv Radiol. Full Text Full Text PDF PubMed Scopus Google Scholar There was no of the of to the there was a in and evidence of with the balloon. study showed loss from the balloon than from the balloon with or I. S. et drug-coated a for the treatment of vascular 2017; PubMed Scopus Google Scholar the on the balloon in a to the target lesion a insertion or in to the trial in the for the paclitaxel-coated balloon an time of and was in the to this was the trial included a an time of was or of patients been study were to for a minimum of following a in the The in 1 showed to the with as in of with no evidence of a difference between The for an in time is on in a angioplasty but there are no with I. S. et drug-coated a for the treatment of vascular 2017; PubMed Scopus Google Scholar The that the study the balloon with a minimum time of that a lower of was to the target lesion that in the study by et using the K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar we that this is a for the A of the trial is that was a It was to that were to treatment of the of the paclitaxel-coated balloon. other as as the patients were and this the of is more that any small of have to a than the that we Patients were to a 6-month clinically or intervention was the was were to stenosis was at the and this was to in the no on the primary outcome of clinically driven A number of in the of the trial the of was after for a clinical indication by a of the clinical to the treatment driven radiological was the for the primary was by a interventional from radiological interventions to loss of were by an interventional from a study or the in In the primary endpoint was of intervention or a to the the have been by of treatment The 6-month in the control was in the and this is than reported in the other J. P. balloon angioplasty in failing fistulas: a randomized controlled J Am Soc Nephrol. 2018; PubMed Scopus Google K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar and D.K. Bunston S. Misra S. et al.Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty--are there clinical predictors of patency?.Radiology. 2004; 232: 508-515Crossref PubMed Scopus (141) Google Scholar, 5Manninen H.I. Kaukanen E.T. Ikaheimo R. et al.Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas--initial success and long-term results.Radiology. 2001; 218: 711-718Crossref PubMed Scopus (113) Google Scholar, 6Heye S. Maleux G. Vaninbroukx J. et al.Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas.Eur J Radiol. 2012; 81: 2298-2303Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 7Manou-Stathopoulou S. Robinson E.J. Harvey J.J. et al.Factors associated with outcome after successful radiological intervention in arteriovenous fistulas: a retrospective cohort.J Vasc Access. 2019; 20: 716-724Crossref PubMed Scopus (7) Google Scholar, 8Aktas A. Bozkurt A. Aktas B. Kirbas I. Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency.Diagn Interv Radiol. 2015; 21: 160-166Crossref PubMed Scopus (26) Google Scholar, 9Turmel-Rodrigues L. Pengloan J. Baudin S. et al.Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology.Nephrol Dial Transplant. 2000; 15: 2029-2036Crossref PubMed Scopus (289) Google Scholar, 10Bountouris I. Kristmundsson T. Dias N. et al.Is repeat PTA of a failing hemodialysis fistula durable?.Int J Vasc Med. 2014; 2014: 369687PubMed Google Scholar The in the control of the study by et was at 6 K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar the of a balloon in patency. a is with a high-pressure plain balloon, there or no benefit in using an paclitaxel-coated balloon. paclitaxel-coated balloons were to improve the outcome in the study by et K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar but in the in mortality has been with the use of paclitaxel-coated balloons in peripheral vascular K. Spiliopoulos S. Kitrou P. et of following of paclitaxel-coated balloons and in the femoropopliteal of the a and meta-analysis of randomized controlled Am 2018; PubMed Scopus Google Scholar was after but after 1 and the was we more in patients with paclitaxel-coated balloons with the control the difference was and the were to any In to the J. P. balloon angioplasty in failing fistulas: a randomized controlled J Am Soc Nephrol. 2018; PubMed Scopus Google K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar patients with a lesion or lesions that by a drug-coated balloon were in the is to the lower in the trial that postintervention access primary patency is in patients with or S. Robinson E.J. Harvey J.J. et al.Factors associated with outcome after successful radiological intervention in arteriovenous fistulas: a retrospective cohort.J Vasc Access. 2019; 20: 716-724Crossref PubMed Scopus (7) Google Scholar at in the access are a and is clinically significant included patients with a stenosis at a in the to that this lesion was for the clinical to To of patients with a treatment we included fistulas that been for of these were the end of access a high of primary of fistula was to the the of a drug-coated balloon to a treatment segment to a and a of the J. P. balloon angioplasty in failing fistulas: a randomized controlled J Am Soc Nephrol. 2018; PubMed Scopus Google K. et balloons for dialysis arteriovenous J Med. 2020; PubMed Scopus Google Scholar The was to the efficacy of paclitaxel-coated and we that this the with we were to this In the results provide no evidence of an benefit from paclitaxel-coated balloons with standard balloons after a clinically driven high-pressure balloon angioplasty in AVFs. any indication of an treatment in the and of the outcomes the has and on an for the other no following to with a to the is by the and a and for The in this are of the and of the or the of and and control balloons were by and no other role in the from the at and and are to and for on trial Katsanos for in the and of the and trial These were and on are in are to the at study in and clinical who to this are to of the patients who to with balloon angioplasty for arteriovenous fistula with interest the investigator-led balloon of stenosis in access trial by Karunanithy et the efficacy of paclitaxel-coated balloons in arteriovenous fistula In to a randomized controlled trial by et the trial to a difference in the treatment of versus standard balloons for AVF The this to the in the has a and and a of a balloon PDF The et the between the results from the balloon of stenosis in access and the trial by et that we this to the use of a or a these as in addition to a number of other PDF

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