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CardioVascular and Interventional Radiology

, Volume 39, Issue 12, pp 1702–1707 | Cite as

The Relationship Between Neutrophil–Lymphocyte Ratio and Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Arteriovenous Fistula Stenosis When Using Conventional and Drug-Eluting Balloons

  • Mehmet Burak ÇildağEmail author
  • Songül Çildağ
  • Ömer Faruk Kutsi Köseoğlu
Clinical Investigation

Abstract

Objective

The aim of this study is to investigate the potential association of neutrophil–lymphocyte ratio (NLR) between primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula stenosis and type (Conventional and Drug-Eluting) of balloons used in PTA.

Material-Method

This retrospective study consists of 78 patients with significant arteriovenous fistulas stenosis who were treated with PTA by using Drug-Eluting Balloon (DEB) (n = 29) or Conventional Balloon (CB) (n = 49). NLR was calculated from preinterventional blood samples. All patients were classified into two groups. Group A; primary patency <12 months (43/78), Group B; primary patency ≥12 months (35/78). Cox regression analysis and Kaplan–Meier method were used to determine respectively independent factors affecting the primary patency and to compare the primary patency for the two balloon types.

Results

NLR ratio and balloon type of the two groups were significantly different (p = 0.002, p = 0.010). The cut-off value of NLR was 3.18 for determination of primary patency, with sensitivity of 81.4 % and specificity of 51.4 %. Primary patency rates between PTA with DEB and CB displayed statistically significant differences (p < 0.05). The cut-off value was 3.28 for determination of 12-month primary patency with the conventional balloon group; sensitivity was 81.8 % and specificity was 81.3 %. There was no statistical relation between NLR levels and the drug-eluting balloon group in 12-month primary patency (p = 0.927).

Conclusion

Increased level of NLR may be a risk factor in the development of early AVF restenosis after successful PTA. Preferring Drug-Eluting Balloon at an increased level of NLR can be beneficial to prolong patency.

Keywords

Arteriovenous fistula Conventional balloon angioplasty Drug-eluting balloon angioplasty Neutrophil–Lymphocyte ratio Primary patency Restenosis 

Notes

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective type of study formal consent is not required.

References

  1. 1.
    Kazemzadeh GH, Modaghegh MHS, Ravari H, Daliri M, Hoseini L, Nataghi M. Primary patency rate of native AV fistula: long term follow up. Int J Clin Exp Med. 2012;5:173–8.Google Scholar
  2. 2.
    III. NKF-K/DOQI Clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001; 37:S137–81.Google Scholar
  3. 3.
    Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int. 2002;62:1109–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Juncos JP, Grande JP, Kang L, et al. MCP-1 contributes to arteriovenous fistula failure. J Am Soc Nephrol. 2011;22(1):43–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Schepers A, Eefting D, Bonta PI, et al. Anti-MCP-1 gene therapy inhibits vascular smooth muscle cells proliferation and attenuates vein graft thickening both in vitro and in vivo. Arterioscler Thromb Vasc Biol. 2006;26:2063–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Marrone D, Pertosa G, Simone S, et al. Local activation of interleukin 6 signaling is associated with arteriovenous fistula stenosis in hemodialysis patients. Am J Kidney Dis. 2007;49(5):664–73.CrossRefPubMedGoogle Scholar
  7. 7.
    Roy-Chaudhury P, Khan R, Campos B, et al. Pathogenetic role for early focal macrophage infiltration in a pig model of arteriovenous fistula (AVF) stenosis. J Vasc Access. 2014;15(1):25–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348:138–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Chang CJ, Ko PJ, Hsu LA, et al. Highly increased cell proliferation activity in the restenotic hemodialysis vascular access after percutaneous transluminal angioplasty: implication in prevention of restenosis. Am J Kidney Dis. 2004;43:74–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Beathard GA. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis. Kidney Int. 1992;42:1390–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee T, Ullah A, Allon M, et al. Decreased cumulative access survival in arteriovenous fistulas requiring interventions to promote maturation. Clin J Am Soc Nephrol. 2011;6:575–81.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Portugaller RH, Kalmar PI, Deutschmann H. The eternal tale of dialysis access vessels and restenosis: are drug-eluting balloons the solution? J Vasc Access. 2014;15(6):439–47.CrossRefPubMedGoogle Scholar
  13. 13.
    Kitrou P, Spiliopoulos S, Katsanos K, Papachristou E, Siablis Karnabatidis D. Paclitaxel-coated balloon angioplasty versus plain balloon angioplasty for dysfunctional arteriovenous fistulae: 1 year results of a prospective randomized controlled trial. J Vasc Interv Radiol. 2015;26:348–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Patanè D, Giuffrida S, Morale W, et al. Drug-eluting balloon for the treatment of failing hemodialytic radiocephalic arteriovenous fistulas: our experience in the treatment of juxta-anastomotic stenoses. J Vasc Access. 2014;15(5):338–43.CrossRefPubMedGoogle Scholar
  15. 15.
    Campos RP. Do Nascimento MM, Chula DC, Do Nascimento DE, Riella MC. Stenosis in hemodialysis arteriovenous fistula: evaluation and treatment. Hemodial Int. 2006;10:152–61.CrossRefPubMedGoogle Scholar
  16. 16.
    Hayashi R, Huang E, Nissenson AR. Vascular access for hemodialysis Nat Clin Pract Nephrol. 2006;2(9):504–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Stolic R. Most important chronic complications of arteriovenous fistulas for hemodialysis. Med Princ Pract. 2013;22(3):220–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Roy-Chaudhury P, Kelly BS, Miller MA, et al. Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts. Kidney Int. 2001;59:2325–34.CrossRefPubMedGoogle Scholar
  19. 19.
    Joviliano EE, Piccinato CE, Joviliano RD, Moriya T, Evora PRB. Inflammatory markers and restenosis in peripheral percutaneous angioplasty with intravascular stenting: current concepts. Ann Vasc Surg. 2011;25:846–55.CrossRefPubMedGoogle Scholar
  20. 20.
    Rectenwald JE, Moldawer LL, Huber TS, et al. Direct evidence for cytokine involvment in neointimal hyperplasia. Circulation. 2000;3:1697–702.CrossRefGoogle Scholar
  21. 21.
    Exner M, Schillinger M, Minar E, et al. Interleukin 6 genotype and restenosis after balloon angioplasty: initial observation. Radiology. 2004;231:839–44.CrossRefPubMedGoogle Scholar
  22. 22.
    Yilmaz H, Bozkurt A, Cakmak M, et al. Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil-lymphocyte ratio (NLR) in chronic hemodialysis patients. Ren Fail. 2014;36(9):1390–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Shimazawa M, Watanabe S, Kondo K, Hara H, Nakashima M, Umemura K. Neutrophil accumulation promotes intimal hyperplasia after photochemically induced arterial injury in mice. Eur J Pharmacol. 2005;520:156–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Turmel-Rodrigues L, Boutin JM, Camiade C, Brillet G, Fodil-Chérif M, Mouton A. Percutaneous dilation of the radial artery in nonmaturing autogenous radial-cephalic fistulas for haemodialysis. Nephrol Dial Transplant. 2009;24:3782–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Mantha M, Killen JP, Baer R, Moffat J. Percutaneous maintenance and salvage of dysfunctional arteriovenous fistulae and grafts by nephrologists in Australia. Nephrology. 2011;16:46–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Heye S, Maleux G, Vaninbroukx J, Claes K, Kuypers D, Oyen R. Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas. Eur J Radiol. 2012;81:2298–303.CrossRefPubMedGoogle Scholar
  27. 27.
    Romann A, Beaulieu MC, Rhéaume P, Clement J, Sidhu R, Kiaii M. Risk factors associated with arteriovenous fistula failure after first radiologic intervention. J Vasc Access. 2016;17(2):167–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Axel DI, Kunert W, Goeggelmann C, et al. Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation. 1997;96:636–45.CrossRefPubMedGoogle Scholar
  29. 29.
    Micari A, Vadala G, Castriota F, et al. 1-year results of Paclitaxel-coated balloons for long femoropopliteal artery disease: evidence from the SFA-long study. JACC Cardiovasc Interv. 2016;9(9):950–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Werk M, Albrecht T, Meyer DR, et al. Paclitaxel-coated balloons reduce restenosis after femoro-popliteal angioplasty: evidence from the randomized PACIFIER trial. Circ Cardiovasc Interv. 2012;5:831–40.CrossRefPubMedGoogle Scholar
  31. 31.
    Scheinert D, Duda S, Zeller T, et al. TheLEVANT I (Lutonix paclitaxel-coated balloon for the prevention of femoropopliteal restenosis) trial for femoropopliteal revascularization: first-inhuman randomized trial of low-dose drug-coated balloon versus uncoated balloon angioplasty. J Am Coll Cardiol Intv. 2014;7:10–9.CrossRefGoogle Scholar
  32. 32.
    Baerlocher MO, Kennedy SA, Rajebi MR, Baerlocher FJ, et al. Meta-analysis of drug-eluting balloon angioplasty and drug-eluting stent placement for infrainguinal peripheralarterial disease. J Vasc Interv Radiol. 2015;26(4):459–73.CrossRefPubMedGoogle Scholar

Copyright information

© EU-Euratom 2016

Authors and Affiliations

  • Mehmet Burak Çildağ
    • 1
    Email author
  • Songül Çildağ
    • 2
  • Ömer Faruk Kutsi Köseoğlu
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyAdnan Menderes UniversityAydınTurkey
  2. 2.Department of Immunology and AllergyAdnan Menderes UniversityAydınTurkey

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