Drug Coated Balloon Angioplasty for Dysfunctional Arteriovenous Fistula: A New Standard-of-Care in the Horizon?

Author(s): Michael Lichtenberg MD, Marianne Brodmann MD

Plain old balloon angioplasty has been a common treatment for arteriovenous fistula (AVF) stenoses; but the latest clinical evidence suggests that drug coated balloons (DCB) significantly increase patency rates and reduce reintervention frequencies.

DCBs delivering the antirestenotic agent paclitaxel have shown to improve outcomes by inhibiting intimal hyperplasia due to the efficient release of the drug into the vessel wall, leading to a diminished proliferation of smooth muscle cells and preventing restenosis. As such, paclitaxelcontaining balloons can improve patency rate and reduce reinterventions in hemodialysis vascular access.

Evidence from clinical trials indicates that different brands of paclitaxel DCBs have different associated performance, due to specific design features, different coating technology and a various drug-ligand interactions.

Besides presenting the clinical evidence of different marketed DCBs for AVF dysfunction, this review gives a further insight into the APERTO OTW (Over-The-Wire) paclitaxel DCB, and its novel SAFEPAX coating technology - specifically designed for hemodialysis vascular access stenoses.

As such, this review intends to guide the interventionalist in their decisionmaking process, knowing that DCBs appear safe when used in arteriovenous access, and seem to provide a benefit in terms of increasing primary patency rates and extending the amount of time between reinterventions.