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Flow in hemodialysis grafts after angioplasty: Do radiologic criteria predict success?
S N Ahya1, D W Windus, T M Vesely
1Renal Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Insights
Angioplasty for venous stenosis improves graft blood flow, but angiographic success doesn't predict flow changes. Pre-procedure blood flow is the best predictor of post-procedure results.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Percutaneous angioplasty is used to treat venous stenosis in hemodialysis grafts.
- Anatomic success is defined by improved vessel diameter and residual stenosis <30%.
Purpose of the Study:
- To assess the correlation between angiographic assessment of venous stenosis and changes in graft blood flow after angioplasty.
Main Methods:
- Twenty-two hemodialysis patients with reduced graft blood flow underwent fistulography and angioplasty.
- Intragraft blood flow was measured pre- and post-angioplasty using the ultrasonic dilution technique.
- Correlation analysis was performed between blood flow changes and morphologic changes in stenosis.
Main Results:
- Mean graft blood flow increased significantly post-angioplasty (457 to 818 mL/min).
- Mean stenosis decreased from 74% to 18% (P < 0.001).
- Pre-angioplasty flow was the only significant predictor of post-angioplasty flow (r2 = 0.22, P < 0.001); angiographic changes did not correlate with flow improvement.
Conclusions:
- Graft blood flow after angioplasty is best predicted by preprocedural flow.
- Angiographic criteria for angioplasty success do not reliably predict blood flow changes.
Background:
The anatomic success of percutaneous angioplasty of venous stenosis is determined by the improvement in cross-sectional diameter of the vessel. A successful outcome is defined as a residual stenosis of <30%. The purpose of this study was to determine whether the angiographic assessment of a venous stenosis correlates with the change in graft blood flow following angioplasty.
Methods:
Twenty-two hemodialysis patients with decreased intragraft blood flow (<700 mL/min) underwent diagnostic fistulography and angioplasty. All grafts were patent at the time of the procedure. Intragraft blood flow was measured before and after angioplasty using the ultrasonic dilution technique. Change in graft blood flow after angioplasty was correlated to the morphologic changes of the treated stenosis.
Results:
The mean preangioplasty and postangioplasty graft blood flows were 457 +/- 136 and 818 +/- 202 mL/min, respectively. The mean degree of stenosis before angioplasty was 74 +/- 15% and 18 +/- 14% after dilation (P < 0.001). The only variable that significantly correlated with postangioplasty blood flow was preangioplasty flow (r2 = 0.22, P < 0.001). The postangioplasty blood flow was not significantly different than the highest recorded blood flow measured in that graft (798 +/- 213 mL/min, P = NS). There was no significant correlation between the change in blood flow and the change in percentage of stenosis.
Conclusion:
Following angioplasty of a venous stenosis, the graft blood flow is most closely predicted by the preprocedural blood flow and is similar to the highest recorded blood flow ever measured in that graft. Angiographic criteria to assess the success of angioplasty are not predictive of changes in blood flow.
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