Drug-Coated Balloon Versus Plain Balloon Angioplasty for the Treatment of Dysfunctional Dialysis Access: A Systematic Review and Meta-analysis.
Qianqian Zhang, Deshuang Zou, Wenqiong Mao et al.
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In 30 seconds
This systematic review and meta-analysis of 25 randomized controlled trials involving 2838 patients compared drug-coated balloon angioplasty (DCBA) with plain balloon angioplasty (PBA) for dysfunctional dialysis access. Compared with PBA, DCBA improved target lesion primary patency at 6 months (RR: 1.27, 95% CI: 1.12-1.43, p<0.001) and 12 months (RR: 1.28, 95% CI: 1.13-1.45, p<0.001), and reduced target lesion revascularization. At 12 months, DCBA did not significantly outperform high-pressure balloon angioplasty for target lesion or access circuit primary patency. Technical success and all-cause mortality were similar.
Key findings
- DCBA improved access circuit primary patency versus PBA at 6 months (RR: 1.25, 95% CI: 1.04-1.40, p=0.002) and 12 months (RR: 1.42, 95% CI: 1.23-1.65, p<0.001).
- Target lesion revascularization was lower with DCBA than PBA at 6 months (RR: 0.60, 95% CI: 0.35-0.80, p=0.003) and 12 months (RR: 0.79, 95% CI: 0.68-0.93, p=0.005).
- At 12 months, DCBA showed no significant advantage over high-pressure balloon angioplasty for target lesion or access circuit primary patency.
- Technical success and all-cause mortality did not differ significantly between DCBA and PBA.
Why it matters
Maintaining dialysis access patency and reducing repeat revascularization are clinically important outcomes. Across randomized trials, DCBA performed better than PBA on these measures, while its advantage over high-pressure balloon angioplasty was not established at 12 months. The findings help distinguish the evidence for DCBA against different balloon comparators, rather than treating plain balloon angioplasty as a single uniform approach.