Development of a Porcine Model of Arteriovenous Fistula Venous Stenosis Treated with Percutaneous Transluminal Angioplasty

Purpose: To develop a porcine model for arteriovenous fistula (AVF) venous stenosis (VS) treated with percutaneous transluminal angioplasty (PTA), and to compare outcomes of plain ordinary balloon angioplasty (POBA) to paclitaxel drug-coated balloon (DCB) angioplasty. Materials and Methods: Twelve castrated male Yorkshire pigs (4–5 months, 35–45 kg) underwent renal artery embolization to induce chronic kidney disease (CKD). Twenty-eight days later, AVF was created by anastomosing the left external jugular vein to left common carotid artery. The pigs were divided into a pilot group (n = 6) for optimizing the AVF technique (euthanized at Day 4) and a definitive group (n = 6) for validating PTA outcomes (euthanized at Day 42). Stenosis developed at juxta-anastomosis 28 days later and was treated with POBA (pilot group, n = 6; definitive group, n = 3) or DCB (definitive group only, n = 3). The definitive group underwent biweekly 4-dimensional flow magnetic resonance (MR) imaging. Results: All animals developed CKD, with significant increases in the levels of blood urea nitrogen (increase of median from 2.6 to 3.2 mmol/L; P < .001) and creatinine (increase of median from 10 to 187 μmol/L, P < .001). In the pilot group, 1 animal had an infected fistula, and AVF patency was 1/5. In the definitive group, the patency was 5/6 because the AVF technique was modified by resecting the sternomastoid muscle and increasing the spatulation. At Day 42 after PTA, the DCB-treated AVF outflow vein showed increasing but statistically insignificant blood flow compared with POBA (DCB, 209.8 mm² ± 64.4, vs POBA, 170.9 mm² ± 95.5; P = .934). Conclusions: A porcine model of AVF VS treated with PTA was developed, with blood flow trends favoring DCB over POBA.