Ultrasonographic evaluation of vascular remodeling and patency after drug-coated balloon treatment for arteriovenous fistula stenosis

Background: Drug-coated balloons (DCBs) have shown promise in prolonging arteriovenous fistula (AVF) patency by inhibiting neointimal hyperplasia. However, few studies have longitudinally evaluated vascular remodeling after DCB treatment using ultrasound. This study aimed to evaluate vascular remodeling after DCB treatment using high-frequency ultrasound. Methods: In this retrospective single-center study, 50 patients with single AVF stenosis were treated with DCB and followed by ultrasound at four time points: pre-treatment, immediately post-treatment, 3 months, and 6 months. Patients were classified into short-term ( n = 24; reintervention within 6–9 months) and long-term ( n = 26; patency ⩾18 months) groups. The mean follow-up time in the long-term group was 24.5 months. Nineteen patients had complete ultrasound data every 3 months up to 15 months. Parameters included lumen cross-sectional area (L-CSA), external cross-sectional area (E-CSA), and intima-media thickness area (IMT area). Results: Baseline demographics were similar between groups. L-CSA was significantly larger in the long-term group both immediately post-DCB (14.4 ± 5.9 vs 9.9 ± 3.9 mm², p < 0.001) and at 6 months (5.3 ± 2.2 vs 3.1 ± 1.3 mm², p < 0.001). E-CSA was also greater in the long-term group at 6 months (21.7 ± 8.8 vs 14.7 ± 5.0 mm², p < 0.001). While there was no significant difference in IMT area immediately post-treatment, it was significantly greater in the long-term group at 6 months (16.3 ± 7.8 vs 11.6 ± 7.8 mm², p < 0.001). No significant changes in L-CSA, E-CSA, or IMT were observed beyond 6 months. Conclusions: Regular ultrasound examinations enable accurate evaluation of vascular remodeling. Initial vessel dilation and sustained external diameter enlargement may contribute to long-term morphological stability and patency following DCB treatment.