Does paclitaxel-coated balloon angioplasty improve the patency of a malfunctioning arteriovenous fistula?

For a failing arteriovenous fistula (an AVF, a surgically created vein-and-artery connection used for dialysis), a paclitaxel-coated balloon appears to help keep the treated area open longer than a standard plain balloon. The strongest evidence comes from a 2026 multicenter randomized controlled trial that compared a scoring paclitaxel-coated balloon (a balloon with a drug coating plus surface scoring elements) against conventional plain balloon angioplasty in adults with malfunctioning mature fistulas or grafts ⁹. At six months, the coated balloon kept the target lesion open in 78.9% of cases versus 57.3% with the plain balloon, a difference of about 21 percentage points that was statistically significant ⁹.

What the research says

The 2026 trial enrolled 219 treated participants across nine centers in China, randomly assigning them to either predilation-free scoring paclitaxel-coated balloon angioplasty or conventional plain balloon angioplasty ⁹. The primary endpoint was 6-month target lesion primary patency, meaning the treated segment stayed open without needing another intervention ⁹. The coated balloon group reached 78.9% patency versus 57.3% for the plain balloon group, with a center-adjusted absolute difference of 21.2 percentage points (95% CI 8.1 to 37.1; P = 0.004) ⁹.

At 12 months, the advantage narrowed and was no longer statistically significant: 63.5% versus 52.4%, an absolute difference of 11.1 percentage points (95% CI -2.2 to 24.4; P = 0.1043) ⁹. This suggests the benefit may be strongest in the first six months and may fade over time, though the trial was likely not powered to detect a smaller difference at one year ⁹. The trial also reported device success, procedural success, clinical success, mortality, and adverse events as secondary outcomes ⁹.

It is worth being clear about what the other available sources do and do not cover. Several sources in this set discuss paclitaxel in completely different contexts, such as treating breast cancer ²³, nasopharyngeal carcinoma ⁸, triple-negative breast cancer ⁷, and mechanisms of paclitaxel resistance in solid tumors ⁵. None of those address arteriovenous fistula patency. Other sources cover AVF-related topics like physical therapy for pain ¹ and self-management interventions ⁴, but neither evaluates paclitaxel-coated balloons. So the question of whether paclitaxel-coated balloon angioplasty improves AVF patency rests almost entirely on the single randomized trial ⁹.

What to ask your doctor

• Ask whether a paclitaxel-coated balloon is an option for my specific fistula and whether it is covered by my insurance or available at my center.
• Ask how the expected benefit (about 21 percentage points better patency at 6 months in the trial) compares with the risks and costs for my situation ⁹.
• Ask what happens if the treated area narrows again, and what the plan would be at 6 months and 12 months.
• Ask whether the benefit seen at 6 months but not clearly at 12 months in the trial matters for how often I might need repeat procedures ⁹.
• Ask about any concerns with paclitaxel coating itself, given that this is a drug-coated device.