Korean J Radiol.  2018 Jun;19(3):410-416. 10.3348/kjr.2018.19.3.410.

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

• Hongsakul
• Bannangkoon K
• Rookkapan
• Boonsrirat U
• Kritpracha B

• KMID: 2410811
• DOI: http://doi.org/10.3348/kjr.2018.19.3.410

Abstract

OBJECTIVE
To report the results of angioplasty with paclitaxel-coated balloons for the treatment of early restenosis of central veins in hemodialysis patients.
MATERIALS AND METHODS
Sixteen patients (9 men and 7 women; mean age 65.8 ± 14.4 years; range, 40-82 years) with 16 episodes of early restenoses of central veins within 3 months (median patency duration 2.5 months) were enrolled from January 2014 to June 2015. Ten native central veins and 6 intra-stent central veins were treated with double paclitaxel-coated balloons (diameter 6-7 mm) plus a high pressure balloon (diameter 12-14 mm). The study outcomes included procedural success (< 30% residual stenosis) and primary patency of the treated lesion (< 50% angiographic stenosis without re-intervention).
RESULTS
Procedural success was achieved in all 16 cases of central vein stenoses. The mean diameter of the central vein was 3.7 ± 2.4 mm before the procedure vs. 11.4 ± 1.8 mm after the initial procedure. There were no procedure-related complications. The mean diameters of the central veins at 6 months and 12 months were 7.8 ± 1.3 mm and 6.9 ± 2.7 mm, respectively. The primary patency rates at 6 months and 12 months were 93.8% and 31.2%, respectively. One patient had significant restenosis of the central vein at 3 months. The median primary patency period was 9 months for paclitaxel-coated balloons and 2.5 months for the last previous procedure with conventional balloons (p < 0.001).
CONCLUSION
In our limited study, paclitaxel-coated balloons seem to improve the patency rate in cases of early restenosis of central veins. However, a further randomized control trial is necessary.

Keyword

Paclitaxel-coated balloon; Patency; Angioplasty; Stenosis; Central vein

MeSH Terms

Angioplasty
Angioplasty, Balloon*
Constriction, Pathologic
Female
Humans
Male
Renal Dialysis*
Veins*

Figure

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  Fig. 1 Angioplasty techniqueA. First, double paclitaxel-coated balloon (each 6-7 mm in diameter) angioplasty was performed. B. Second, high pressure balloon (12-14 mm) angioplasty was performed.

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  Fig. 2 Kaplan-Meier curve for primary patency at 3, 6, 9, and 12 months after procedure

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  Fig. 3 55-year-old patient with early recurrent significant stenosis of left brachiocephalic veinA. Initial angiography shows significant stenosis of left brachiocephalic vein (arrow). B. Immediate angiography after procedure shows no stenosis of left brachiocephalic vein. C. Angiography at 6 months shows no recurrent stenosis (arrow). D. Angiography at 12 months shows no significant stenosis (arrow).

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  Fig. 4 65-year-old patient with early recurrent significant stenosis of left subclavian veinA. Initial angiography shows severe stenosis of left subclavian vein (arrow). B. Immediate angiography after procedure shows no stenosis of left subclavian vein. C. Angiography at 3 months shows significant restenosis of left subclavian vein (arrow).

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  Fig. 5 Kaplan-Meier curve comparing primary patency between historical data after last PBA and PCBA in same patientsMedian patency times for PBA and PCBA were 2.5 months and 9 months, respectively (p < 0.001). PBA = plain balloon angioplasty, PCBA = paclitaxel-coated balloon angioplasty

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