Assessing the value of stenting procedure versus balloon angioplasty for the treatment of arteriovenous fistula stenosis

Principal investigators: Carla Rognoni  

Team UB/Cergas: Carla Rognoni – Ludovico Cavallaro – Aleksandra Torbica – Rosanna Tarricone 

Client: Becton Dickinson Italia S.p.A.

Duration: 9 months

Abstract:

Balloon angioplasty and stent placement are minimally invasive procedures used to treat narrowing (stenosis) or blockages in arteriovenous fistulas (AVFs), which are essential for dialysis in kidney disease patients. In balloon angioplasty, a catheter with a small balloon is inserted into the AVF and inflated to widen the narrowed area, improving blood flow. To prevent the vessel from narrowing again or in cases of recurrent stenosis, a stent—a metal mesh tube—may be placed. The stent is expanded to fit the vessel wall and remains in place to support the vessel and maintain blood flow. These procedures help restore and maintain adequate blood flow in the AVF, ensuring efficient dialysis. While angioplasty alone may result in re-narrowing, the addition of a stent reduces this risk. Potential complications include restenosis and stent thrombosis, but these interventions generally improve AVF function with a faster recovery compared to surgical alternatives. The aim of the project is to support the stakeholders in Italy in the overall evaluation of the management of patients with stenosis of AVFs.

Methods:

A cost-effectiveness analysis (CEA) will be conducted from the National Healthcare Service (NHS) perspective in Italy to compare stenting with balloon angioplasty. The NHS perspective for the CEA will provide the cost-effectiveness profile of stenting to support the adoption of this innovative technology at national level. The preliminary phase consists in gathering all available clinical and economic evidence on stenting and balloon angioplasty through a systematic literature review to facilitate a comprehensive comparison.