Utilization of Network Meta-analysis of Randomized Controlled Trials to Compare Different Types of Balloon Angioplasty for Arteriovenous Fistula Stenosis

Multiple databases were reviewed systematically to identify published randomized controlled trials (RCTs) studies on comparing balloon angioplasty in patients with dysfunctional AVF up to August 2023. The following types of balloons were compared: drug-coated balloon (DCB), cutting balloon (CtB), high-pressure balloon (HPB), and PBA. Indirect comparisons of all balloon types were compared using random-effect network meta-analysis (NMA). The primary outcomes were primary patency rates of the AVF at 3, 6, 9, and 12 months. The P-score (estimate of the probability of being the best treatment) was used to rank the types of balloons for each outcome.

Results:

Twenty-three RCTs involving 2,951 patients were included. Direct meta-analyses showed, compared to PBA, higher primary patency rates at 3 months in CtB (OR=1.23, 95%CI[1.05-1.44]) group, at 6 months in CtB (OR=1.52, 95%CI[1.05-2.20]) and DCB (OR=1.19, 95%CI[1.02-1.38]) groups, at 9 months in DCB group (OR=1.41, 95%CI[1.15-1.73]), and at 12 months in DCB group (OR=1.38, 95%CI[1.04-1.82]). NMA showed that DCB was ranked as the best option based on P-score on 9-, and 12-month patency rates (Table 1). HPB was ranked the highest in terms of technical success. Direct meta-analysis showed significantly higher technical success in HPB compared to PBA (OR=1.23, 95%CI[1.08-1.41]). A comparison of all-cause mortality between DCB and PBA indicated no statistical difference (OR=0.89, 95%CI[0.66-1.20]) (Figure 1).

Conclusions:

Based on evidence from 23 trials, DCB is superior to PBA in preserving primary patency in patients with AVF stenoses. HPB serves a greater technical success compared to PBA.