Efficacy of High-Pressure Balloon for the Treatment of Arteriovenous Fistula Stenosis: A Meta-Analysis

Abstract

Objective: The objective of the present study was to compare the effectiveness of high-pressure balloon (HPB) versus conventional balloon (CB) angioplasty in treating arteriovenous fistula (AVF) stenosis. Materials and Methods: A meta-analysis was conducted using data acquired from PubMed, EMBASE, the Cochrane Library, SinoMed, CNKI, WanFang, and VIP databases from the time the databases were established to December 2020. All analyses included in the studies comprised the subgroups of HPB and CB. The patency rates of AVF were compared between 2 groups at 3, 6, and 12 months after operation. Results: Seven studies comprising 364 patients were included in the meta-analyses. The pooled results revealed that restenosis rate of AVFs treated with HPB was significantly lower than that of AVFs treated with CB at 3 months (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.16 to 0.61, p<0.001) and 6 months after operation (OR= 0.29, 95% CI = 0.11 to 0.79, p = 0.01). In addition, the technical success rate of HPB groups was higher (OR = 0.13, 95% CI = 0.05 to 0.36, p<0.001). However, no significant difference was observed between HPB and CB groups at 12 months after operation (OR = 0.68, 95% CI = 0.30 to 1.52, p = 0.35). No significant publication bias was observed in the analyses. Conclusion: High-pressure balloon is a potential option for the treatment of AVF stenosis, with a lower 3- and 6-month restenosis rate than CB. However, 12-month patency rate of HPB was not superior to CB. Therefore, further studies should be conducted to investigate the mechanisms of restenosis after angioplasty.