Vessel preparation with FLEX Vessel Prep device prior to paclitaxel-coated angioplasty improves outcomes of hemodialysis vascular access

Purpose: Long-term vascular access (VA) is critical for patients with kidney disease or hyperlipoproteinemia, yet stenotic lesions often compromise its patency, necessitating frequent interventions. This study compares the efficacy of three endovascular treatment modalities—plain old balloon angioplasty with drug-coated balloon (POBA+DCB), scoring balloon with drug-coated balloon (SB+DCB), and FLEX vessel preparation with drug-coated balloon (VP+DCB)—in the treatment of VA stenoses. Materials and methods: A retrospective analysis was conducted on 175 VA interventions performed between June 2022 and October 2024 at a dedicated VA center. Patients were divided into three groups based on treatment modality: POBA+DCB ( n = 57), SB+DCB ( n = 47), and VP+DCB ( n = 71). Technical success was achieved in all cases, and complete balloon effacement was highest in the POBA and VP groups (100%) compared to SB (91.5%, p = 0.0046). Results: Reinterventions per patient-year were significantly lower in the VP group (0.372) compared to POBA (0.695) and SB (0.917) ( p < 0.0001). Patency outcomes favored VP+DCB, with target lesion primary patency (TLPP) rates at 6 and 12 months of 86.0% and 73.6%, respectively, compared to 79.1% and 40.1% for POBA and 67.7% and 41.2% for SB. Access circuit primary patency (ACPP) at 6 and 12 months was 84.7% and 57.0% for VP, 78.5% and 37.9% for POBA, and 65.4% and 35.6% for SB. In multivariate analysis, prior interventions and reintervention frequency significantly impacted patency loss. Conclusions: These findings suggest that VP+DCB may provide superior patency and reduced reintervention rates compared to POBA+DCB and SB+DCB, offering a promising alternative for the management of VA-stenoses in real-world clinical settings.