Efficacy of high-pressure balloon for the treatment of arteriovenous fistula stenosis: a meta-analysis

Objective: The objective of the present study was to compare the effectiveness of high-pressure balloon (HPB) versus conventional balloon angioplasty (BA) in treating arteriovenous fistula (AVF) stenosis. Materials and Methods: A meta-analysis was conducted using data acquired from PubMed, EMBASE, the Cochrane Library, SinoMed, CNKI, WanFang and VIP databases from the time the databases were established to November 2020. All analyses included in the studies comprised the subgroups of HPB and BA. The patency of AVF was compared between the two groups at 3 months, 6 months and 12 months after operation. Results: Nine studies comprising 475 patients were included in the meta-analysis. The pooled results revealed that stenosis rate of AVFs treated with HPB was significantly lower than that of AVFs treated with conventional balloon at 3 months (OR= 0.37, 95% CI 0.21 to 0.67, p<0.001) and 6 months after operation (OR= 0.33, 95% CI 0.15 to 0.75, p=0.008). In addition, the technical success rate of HPB groups was high (OR= 0.14, 95% CI 0.05 to 0.35, p<0.001). However, no significant difference was observed between the experimental and control groups at 12 months after operation (OR= 0.61, 95% CI 0.29 to 1.25, p=0.18). No significant publication bias was observed in the analyses. Conclusion: HPB is a potential primary option for the treatment of AVF stenosis, with a lower 3- and 6-month stenosis rate than BA. However, the long-term effect of HPB was not satisfactory; therefore, further research should be conducted to elucidate the relationship between the two groups.