Mortality After Paclitaxel-Coated Device Use in Dialysis Access: A Systematic Review and Meta-Analysis

Autor: Alexandra M. Limmer, Sharath C.V. Paravastu, Shannon D. Thomas, Ramon L. Varcoe, Andrew Holden, Michael H Bennett, Krystal Dinh
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Time Factors
Percutaneous
Paclitaxel
medicine.medical_treatment
Arteriovenous fistula
030204 cardiovascular system & hematology
Prosthesis Design
Risk Assessment
030218 nuclear medicine & medical imaging
Blood Vessel Prosthesis Implantation
03 medical and health sciences
chemistry.chemical_compound
Dialysis access
Arteriovenous Shunt
Surgical
0302 clinical medicine
Coated Materials
Biocompatible
Renal Dialysis
Risk Factors
medicine
Humans
Radiology
Nuclear Medicine and imaging
Treatment Failure
Aged
Randomized Controlled Trials as Topic
Aged
80 and over
business.industry
Graft Occlusion
Vascular
Cardiovascular Agents
Drug-Eluting Stents
Middle Aged
Device use
medicine.disease
Surgery
Stenosis
chemistry
Meta-analysis
Female
Hemodialysis
Cardiology and Cardiovascular Medicine
business
Angioplasty
Balloon
Vascular Access Devices
Zdroj: Journal of Endovascular Therapy. 26:600-612
ISSN: 1545-1550
1526-6028
DOI: 10.1177/1526602819872154
Popis: Purpose: To report the risk of all-cause mortality in patients who underwent dialysis access treatment using paclitaxel-coated devices compared with percutaneous transluminal angioplasty (PTA) with an uncoated balloon. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials were performed to investigate the mortality outcomes associated with paclitaxel-coated devices in the treatment of patients with a failing dialysis access (last search date February 28, 2019). The primary endpoint was all-cause mortality. This analysis included 8 studies comparing paclitaxel-coated balloon (PCB) angioplasty (n=327) and PTA (n=331) in the treatment of failing dialysis access. None investigated paclitaxel-coated stents. Mortality data were pooled using a random effects model. Statistical heterogeneity was evaluated with a chi-square test and the I2statistic. Summary statistics are expressed as relative risk ratios (RR) with a 95% confidence interval (CI). Results: At the pooled mean follow-up of 13.5 months (median 12, range 6–24) all-cause mortality was similar in the PCB group (13.8%) compared with PTA (11.2%; RR 1.26, 95% CI 0.85 to 1.89, p=0.25; I2=0%). Subgroup analysis, stratified according to length of follow-up, confirmed that there were no statistically significant differences in mortality at short- and midterm follow-up [6-month (8 studies): 5.2% vs 4.8%, RR 1.24, 95% CI 0.62 to 2.47, p=0.55; 12-month (6 studies): 6.3% vs 6.0%, RR 1.06, 95% CI 0.43 to 2.63, p=0.90; and 24-month (3 studies): 19.0% vs 13.5%, RR 1.38, 95% CI 0.90 to 2.12, p=0.14). Conclusion: The analysis found no difference in short- to midterm mortality among patients treated with a drug-coated balloon compared with PTA. With proven benefit and no evidence of harm, the authors recommend ongoing use of PCB for the failing dialysis access.
Databáze: OpenAIRE
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