Does paclitaxel-coated balloon angioplasty improve the 6-month patency of an arteriovenous fistula?

For a failing arteriovenous fistula (AVF), a surgically created vein used for hemodialysis, keeping the access open matters a lot. One option is angioplasty, where a small balloon is inflated inside the narrowed vein to reopen it. Coating that balloon with the drug paclitaxel is meant to stop the narrowing from coming back. The short answer: a 2026 randomized trial found that a paclitaxel-coated balloon did improve 6-month patency compared with a plain balloon, but the benefit was smaller at 12 months and other pooled analyses are less clear-cut ⁹¹⁰¹¹.

What the research says

The most direct evidence comes from a 2026 multicenter randomized controlled trial in China that enrolled 219 adults with malfunctioning mature arteriovenous fistulas or grafts ⁹. Participants were split into two groups: one treated with a scoring paclitaxel-coated balloon (no predilation needed) and one with a conventional plain balloon. At 6 months, target lesion primary patency (the lesion staying open without needing another procedure) was 78.9% in the coated-balloon group versus 57.3% in the plain-balloon group, an absolute difference of about 21 percentage points that was statistically significant ⁹. At 12 months, the gap narrowed to 63.5% versus 52.4%, and that difference was no longer statistically significant ⁹.

What to ask your doctor

• Given my fistula's specific problem, would a drug-coated balloon or a plain balloon be the better choice for me?
• What are the realistic chances my fistula stays open at 6 months and at 12 months with each option?
• How often might I need a repeat procedure, and what does that mean for my dialysis schedule?
• Are there any risks or safety concerns with a paclitaxel-coated balloon I should know about?
• What other options exist if angioplasty does not keep my fistula working well enough?