Effectiveness of second drug-coated balloon angioplasty for arteriovenous fistulas following initial treatment failure with first-generation DCBs

Introduction: Percutaneous transluminal angioplasty (PTA) is the global standard for treating dysfunctional arteriovenous fistulas (AVF). However, PTA can cause vessel wall damage and intimal hyperplasia, leading to restenosis and the need for reintervention. The drug-coated balloon (DCB) is a novel approach for managing recurrent dysfunction in AVFs. However, there is limited information on the optimal number of DCB treatments required. Specifically, it is uncertain whether a second DCB should be performed in patients in whom the initial treatment with the first DCB was ineffective. Methods: This single-center, retrospective observational study aimed to evaluate the effectiveness of a second DCB treatment in 40 patients. A second DCB was performed if PTA was required generally within 90 days after the first DCB, indicating failure of the first DCB treatment. Results: The results showed a significant difference in patency following the second DCB compared to conventional balloon treatment (χ² = 20.46, p < 0.001) and between the first and second DCB treatments (χ² = 11.41, p = 0.0007). Univariate logistic regression analysis indicated that patients with thinner maximum intimal hyperplasia had significantly longer assisted primary patency periods ( p = 0.006). Furthermore, receiver operating characteristic curve analysis to assess the sensitivity-specificity profile of the second DCB’s effectiveness showed that the optimal threshold for maximum intimal hyperplasia was 1.2 mm (sensitivity/specificity, 0.80/0.58). Conclusion: Our findings suggest that a second DCB treatment is effective for patients whose first DCB was unsuccessful, particularly in those with maximum intimal hyperplasia thinner than 1.2 mm.