Correlation of intragraft blood flow with characteristics of stenoses found during diagnostic fistulography

To determine if intragraft blood flow measurements correlate with the anatomical characteristics of stenoses found during diagnostic fistulography.

This investigation was a retrospective review of 40 patients with decreased intragraft blood flow (<600 mL/min) in patent polytetrafluoroethylene hemodialysis grafts who underwent diagnostic fistulography and angioplasty. Intragraft blood flow was measured with the ultrasonic dilution technique. The fistulogram images were reviewed and the anatomic characteristics of all stenoses were measured and recorded. These characteristics were correlated with the intragraft blood flow values.

The mean intragraft blood flow was 476 mL/min (range, 270-600 mL/min). Fistulography revealed a total of 71 stenoses and all 40 patients had at least one lesion with > 50% stenosis. There was no correlation between the intragraft blood flow and the location, length, or number of stenoses. There was a moderate inverse correlation between the intragraft blood flow and the degree of stenosis (P =.08). Fifty-nine stenoses were treated with angioplasty. The mean postangioplasty blood flow was 796 mL/min (range, 470-1565 mL/min). The mean change in blood flow after angioplasty was 311 mL/min (range, 15-1154 mL/min) There was no association between the change in blood flow after angioplasty and the number, length, or degree of residual stenosis.

Intragraft blood flow < 600 mL/min is an excellent predictor of the presence of at least one significant (>/=50%) stenosis. There was an inverse correlation between intragraft blood flow and the degree of stenosis. There was no association between the intragraft blood flow and the location, length, or number of stenosis.