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Outcomes from the CONCERTO (COmbiNing Cutting and drug-Eluting balloon for Resistant arteriovenous fistula sTenOsis) Pilot Study

Presented During:

Sat, 6/13/2020: 12:14 PM  - 12:23 PM 
Webinar  
Room: Webinar  

Final ID:

14 

Authors:

M Wang1, K Zhuang1, K Tay1, F Irani1, A Gogna1, A Patel1, R Lo1, K Damodharan1, S Leong1, N Karaddi Venkatanarasimha1, S Chan1, C Too1, S Chandramohan1, P Kumar1, J Chua1, L Toh2, K Lee1, S Tashi1, B Tan1

Institutions:

1Singapore General Hospital, Singapore, 2KK Women's and Children's Hospital, Singapore

First Author:

Mark Wang  
Singapore General Hospital
Singapore

Co-Author(s):

Kun Da Zhuang  
Singapore General Hospital
Singapore
Kiang Hiong Tay  
Singapore General Hospital
Singapore
Farah Gillan Irani  
Singapore General Hospital
Singapore
Apoorva Gogna, MBBS FRCR  
Singapore General Hospital
Singapore
Ankur Patel  
Singapore General Hospital
Singapore
Richard Hoau Gong Lo  
Singapore General Hospital
Singapore
Karthikeyan Damodharan  
Singapore General Hospital
Singapore
Sum Leong  
Singapore General Hospital
Singapore
Nanda Kumar Karaddi Venkatanarasimha  
Singapore General Hospital
Singapore
Shaun Xavier Ju Min Chan  
Singapore General Hospital
Singapore
Chow Wei Too  
Singapore General Hospital
Singapore
Sivanathan Chandramohan, MRCS, FRCR  
Singapore General Hospital
Singapore
Pradesh Kumar  
Singapore General Hospital
Singapore
Jasmine Chua, MBBS  
Singapore General Hospital
Singapore
Luke Michael Han Wei Toh, MD  
KK Women's and Children's Hospital
Singapore
Kristen Lee, MD  
Singapore General Hospital
Singapore
Sonam Tashi  
Singapore General Hospital
Singapore
Bien-Soo Tan, MBBS, FRCR, FSIR  
Singapore General Hospital
Singapore

Presenting Author:

Mark Wang  
Singapore General Hospital
Singapore, Singapore

Purpose:

To evaluate the feasibility and safety of combined cutting and drug-eluting balloon angioplasty (C+DEB PTA) for treatment of dysfunctional dialysis arteriovenous fistula (AVF) stenoses resistant to conventional balloon angioplasty (cPTA).

Materials:

This single-arm, open-label pilot study recruited 19 patients (12 males; mean age 64.9 ± 8.6 years) from August 2018 to January 2019. The main inclusion criterion was the presence of ≥30% residual stenosis on post cPTA venogram of the target lesion, following cPTA with an appropriately sized balloon (inflated to rated burst pressure or 15 atmospheres, whichever is lower, at least twice for 1 minute each). A cutting balloon (up to 1.1:1 balloon-to-vessel ratio) followed by a drug-eluting balloon (similar or up to 1 mm larger than vessel) were used to treat the target lesion. The primary outcome measure was postintervention target lesion patency1 on clinical follow-up at 6 months.

Results:

The degree of residual stenosis was 48.8 ± 11.3% and 18.7 ± 10.4%, after cPTA and C+DEB PTA respectively. Technical success was achieved in 18 cases (94.7%), with one failure due to persistent residual stenosis. At 6 months, postintervention target lesion patency was 100% (n=19), however postintervention primary patency1 was 94.7% (n=18) due to non-target lesion recurrent stenosis. No venous rupture or major complication was encountered. No patients were lost to follow-up.

Conclusions:

C+DEB PTA is a feasible, safe and promising treatment option in AVF stenosis resistant to cPTA.

Abstract Categories:

Dialysis Interventions

Keywords:

Arteriovenous fistula
cutting balloon angioplasty
drug eluting balloon