Comparative efficacy of five balloons for treating autogenous arteriovenous fistula stenosis: a Bayesian network meta-analysis

BACKGROUND: Arteriovenous fistula (AVF) was the lifeline of patients with maintenance hemodialysis (MHD). However, stenosis of AVF may limit its use. Currently, AVF stenosis is commonly treated with balloon angioplasty. Meanwhile, several balloons were available. Therefore, this study aimed to explore the effectiveness of angioplasty with five different balloons in patients with AVF stenosis. METHODS: A network meta-analysis (NMA) was performed to synthesize direct and indirect evidence. We carried out a comprehensive literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and ClinicalTrials.gov databases from database inception to January 31, 2021. The main outcomes were primary patency rates of AVF after 3, 6, 9, and 12 months. The NMA was performed using Stata 15 (network and mvmeta commands) and GeMTC software. RESULTS: Twenty randomized controlled trials (RCTs) involving 2,607 participants were included. Direct meta-analyses revealed no significant difference in primary patency rates between different balloons after 3, 6 and 9 months. However, NMA demonstrated that the effectiveness of plain balloon angioplasty (PBA) was inferior to that of the drug-coated balloon (DCB) after 3 and 9 months. Moreover, the results suggested that the high-pressure balloon (HPB) was inferior to DCB after 9 months. Thereafter, the analysis of the surface under the cumulative ranking curve (SUCRA) revealed that DCB was ranked as the first effective treatment after 3 months. The drug-eluting balloon (DEB) was the most effective treatment after 6, 9, and 12 months. The analyses revealed no significant publication bias. DISCUSSION: DEB may be the most effective treatment of AVF stenosis, followed by DCB. However, prospective studies involving large sample sizes of clinical trials and a direct comparison between DEB and DCB are required to clarify the individual value of different treatment options.