Combined drug-coated balloon and bare metal stent implantation for refractory recurrent venous anastomotic stenosis in arteriovenous grafts: an exploratory cohort study

Refractory recurrent venous anastomotic stenosis remains a major challenge to maintaining primary patency of arteriovenous grafts (AVG). This exploratory study evaluated whether drug-coated balloon (DCB) angioplasty combined with bare-metal stent (BMS) implantation was associated with longer target lesion patency than percutaneous transluminal angioplasty (PTA) alone in this difficult lesion subset. This retrospective single-center cohort included 58 patients treated between January 2022 and April 2024. Patients were classified according to the treatment received as PTA ( n = 37) or DCB + BMS ( n = 21). Primary patency was evaluated using Kaplan–Meier analysis and Cox proportional hazards regression. The DCB + BMS group demonstrated longer median target primary lesion patency (28.71 weeks) compared with PTA group (12.29 weeks, p < 0.001), with a 4-month primary patency rate of 70.83% vs. 0%. Cox regression identified DCB + BMS as independently associated with reduced access failure risk (HR 0.271, 95% CI 0.150–0.489, p < 0.001). In this exploratory cohort study, DCB + BMS was associated with prolonged patency compared with PTA alone in patients with refractory recurrent AVG stenosis. This study was not registered as it is a retrospective analysis of clinical practice data, not a prospective clinical trial. The datasets generated and analyzed during this study are available from the corresponding author on reasonable request.