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Published on: April 28, 2013
Hemodynamics of failing dialysis grafts
K L Sullivan1, A Besarab, J Bonn
1Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
Insights
Graft pressures indicate stenosis severity in failing hemodialysis grafts. Pressures above 40% stenosis signal significant issues, guiding intervention needs.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Hemodialysis grafts are crucial for patients with end-stage renal disease.
- Graft failure, often due to stenosis, necessitates timely intervention.
- Accurate assessment of stenosis severity is vital for effective treatment.
Purpose of the Study:
- To evaluate the relationship between stenosis severity and pressure gradients in failing hemodialysis grafts.
- To determine the diagnostic value of graft pressures in identifying hemodynamically significant stenoses.
- To establish pressure targets for successful percutaneous intervention.
Main Methods:
- Prospective study of 104 hemodialysis grafts undergoing angiographic examination.
- Measurement of graft and central vein pressures.
- Correlation of pressure measurements with stenosis severity (greater than 40% lumen reduction).
Main Results:
- Stenosis exceeding 40% caused a significant increase in graft pressure.
- Grafts with <40% stenosis had venous/arterial limb pressures of 31%/45% of systemic systolic pressure.
- Grafts with >40% stenosis had venous/arterial limb pressures of 53%/75% of systemic systolic pressure.
- Graft thrombosis occurred with greater lumen reduction in central vein stenoses than anastomotic stenoses.
Conclusions:
- Dialysis graft pressures are effective indicators of stenosis hemodynamic significance.
- Percutaneous intervention should aim for specific pressure reduction targets.
- Intervention should target venous limb pressures <33% and arterial limb pressures <50% of systemic pressure.
Abstract:
Pressures were measured in the graft and the central vein during 104 consecutive angiographic examinations of failing hemodialysis grafts. Stenosis severity greater than 40% led to a statistically significant rise in graft pressure. In grafts in which all stenoses were of 40% or less severity, the systolic pressures in the venous and arterial limbs of the grafts were 31% +/- 16 and 45% +/- 17, respectively, of systemic systolic pressure. In grafts in which the highest grade of stenosis was greater than 40%, pressures in the venous and arterial limbs of the grafts were 53% +/- 25 and 75% +/- 24, respectively, of systemic systolic pressure. Graft thrombosis tended to occur at a higher degree of lumen reduction (but at similar pressures) with central vein stenoses compared with venous anastomotic stenoses. Dialysis graft pressures can help determine the hemodynamic importance of stenoses and the need for intervention. Percutaneous intervention should achieve arterial and venous limb pressures of less than 50% and 33% of systemic pressure, respectively.
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