Network meta-analysis of trials comparing first line endovascular treatments for arteriovenous fistula stenosis.

Gregory, Tripsianis; Eleni, Christaina; Christos, Argyriou; Efstratios, Georgakarakos; George, Georgiadis S; Miltos, Lazarides K

OBJECTIVE To investigate the comparative effectiveness of the different endovascular treatments in patients with failing autogenous arteriovenous fistulas (AVFs) with outflow vein stenosis. MATERIALS AND METHODS Medline/PubMed and SCOPUS databases were searched. Systematic review and network meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness of plain balloon angioplasty (PBA), cutting balloon angioplasty (CtBA) and drug coated balloon angioplasty (DCBA) in autogenous AVFs vein stenoses were performed; studies on central vein stenoses were excluded. The main outcome measures were failure rates at 6-months and 1-year. RESULTS Eleven RCTs were included reporting a total of 814 patients and 395 out of them underwent PBA. Network meta-analysis showed that DCBA at 6-months was significantly more effective than PBA [Odds ratio (OR): 0.39, Confidence Intervals (CI):0.18-0.81] and ranked as the best treatment option, but without having statistically significant difference when compared with CtBA (OR: 0.65, CI: 0.20-2.12). Statistical significance was not achieved at 1 year among treatments. Additional conventional pair-wise meta-analyses did not find significant differences at 1-year. CONCLUSION In failing AVFs with outflow stenosis, DCBA is significantly superior to PBA presenting an improved 6-month failure rate. However the effectiveness of DCBA in the long term deserves further investigation.