Pasteur Rasuli MD, FRCPC, Presenter: Nothing to Disclose

Stephen Ryan MD, PhD, Abstract Co-Author: Nothing to Disclose

Jose Aquino MD, FRCPC, Abstract Co-Author: Nothing to Disclose

Gordon J. French MD, Abstract Co-Author: Nothing to Disclose

Adnan Hadziomerovic MD, Abstract Co-Author: Nothing to Disclose

Francois Pomerleau BSc, BASc, Abstract Co-Author: Nothing to Disclose

Rima Aina MD, Abstract Co-Author: Nothing to Disclose

Kevin O'Kelly MD, FRCPC, Abstract Co-Author: Nothing to Disclose

Janet Graham BA, Abstract Co-Author: Nothing to Disclose

Ram Prakash Galwa MD, Abstract Co-Author: Nothing to Disclose

To prospectively compare the primary patency rates following high pressure conventional balloon angioplasty versus cutting balloon angioplasty as first time treatment in patients with new stenoses in AV fistulas for hemodialysis.

Thirty-five patients (mean age, 67± 12 years) M/F ratio of 20/15 with 9 radiocephalic and 26 brachioscephalic AV fistulas for hemodialysis, undergoing their first percutaneous balloon angioplasty between Sept 17 2009 to November 9, 2010 were randomized to undergo balloon angioplasty with conventional high pressure balloon 4-8 mm in diameter versus those getting angioplasty with cutting balloon of similar diameters. Patients requiring balloons larger than 8 mm were excluded as there are no cutting balloons manufactured larger than 8 mm. The two groups were comparable in age, gender location and length of the stenotic lesions. The primary patency was assessed after a median follow up period of 350 days. Additionally, effects of length and location of the stenosis on the outcome were evaluated.

All procedures were technically successful. Four patients requiring 10 mm balloons were excluded. One patient died of unrelated causes, and one withdrew from dialysis care. The primary patency rate in the remaining 29 patients (14 patients with cutting balloon and 15 with conventional high pressure balloon angioplasty was calculated to be 252.4+/-164 days after conventional balloon angioplasty and 237+/- 137 days in the cutting balloon group. The difference was not statistically significant. At the end of the study period 4 patients in cutting balloon group, and 5 in conventional balloon group were still patent unassisted. The single procedure-related complication was an inconsequential easily-managed venous rupture with a cutting balloon. The length and location of the stenosis did not have a significant impact on the patency outcome, although there was a trend with conventional balloons vs. cutting balloons for longer patency in segmental lesions (283 vs.189 days). 

In comparison with high pressure conventional balloons, cutting balloon angioplasty does not improve the primary patency in the newly developed stenotic lesions in AV fistulas for hemodialysis.

Our study suggests that despite a 6:1 price differential, cutting balloons do not improve the primary patency rate compared with conventional high pressure balloons in the new  AV fistula stenoses.

Rasuli, P, Ryan, S, Aquino, J, French, G, Hadziomerovic, A, Pomerleau, F, Aina, R, O'Kelly, K, Graham, J, Galwa, R, Comparison of Primary Patency Following Cutting Balloon vs High-Pressure Balloon Angioplasty for Treatment of New Venous Stenoses of Native Hemodialysis Fistulas.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034206.html