Distal Radial Artery Pressures Predict Angiographic Result and Short‐Term Patency Outcome in Hemodialysis Patients With Juxta‐Anastomotic Inflow Stenosis of Radiocephalic Fistula Undergoing Transradial Angioplasty

Abstract

Distal radial artery pressure (RAP) was observed to be reduced after transradial percutaneous transluminal angioplasty (PTA) on the juxta-anastomotic venous stenosis of radiocephalic arteriovenous fistula (RCAVF). Distal RAPs are easily obtained from a pressure transducer connected with an introducer retrograde inserted into distal radial artery. The clinical role of distal RAP in the setting of transradial PTA remains unknown. This prospective and observational study aimed to explore the relationship between distal RAPs and clinical outcomes. This study recruited hemodialysis patients with RCAVF juxta-anastomotic venous stenosis undergoing transradial PTA. RAP-related variables and procedural data before PTA (pre-PTA) and after PTA (post-PTA) were analyzed. The study endpoint was dysfunction-driven re-PTA during the 1-year follow-up. Overall, 73 PTAs significantly reduced the mean of systolic RAPs from 159.6 ± 41.4 to 108.4 ± 41.5 mm Hg; P < 0.0001. Post-PTA systolic RAP was associated with angiographic outcome (P = 0.004) and unassisted patency at 3 months (P = 0.036), but not at 6, 9, or 12 months (P > 0.05). The group with angiographically successful PTAs had a significantly lower mean of post-PTA systolic RAPs compared with that with unsuccessful PTAs (98.4 ± 35.4 vs. 128.7 ± 46.1 mm Hg; P = 0.003). The post-PTA systolic RAP may be seen as a predictor for 3-month unassisted patency (AUC = 0.669; P = 0.048). In conclusion, this study provides the RAP profile to help guide transradial PTA on RCAVF juxta-anastomotic venous stenosis and predict 3-month unassisted patency in a hemodynamic manner.

Sentinel vascular access monitoring after endovascular intervention predicts access outcome

“…The study also had nearly 60% procedure failure and residual stenosis of >60% reinforcing angiography’s weakness as a marker of efficiency. Lai et al 11 also reported distal radial artery pressure measured at the time of procedure as a marker of angiographic outcomes and 3-month primary access patency. Reported studies to date are limited to intraprocedural measurements that require additional resources, adds to procedure times, cost, and specific access types.…”

“…10 Distal radial artery pressure gradient, translesional pressure ratio, and catheter-based flow studies are proposed to predict technical and patency outcomes in limited VA types and require additional resources. [11][12][13][14] These adjunctive methods are useful intraprocedure but have limited applicability across various access types and clinical settings.…”

Translesional Pressure Ratio Predicts Technical Outcome and Patency in Angioplasty on Outflow Stenosis of Hemodialysis Graft

“…Although the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative clinical practice guideline has recommended angiographic and hemodynamic criteria for determining technical success in percutaneous transluminal angioplasty (PTA) on dysfunctional arteriovenous access (1), inconsistent angiographic and functional results are commonly encountered (2–4). Several hemodynamic parameters have been applied to help evaluate the lesions in addition to visually angiographic assessments, such as an intra-access pressure (5–7), distal radial artery pressure (8), a pressure ratio of the intra-access pressure over systemic artery pressure (9–11) and an access blood flow (3, 12, 13). A translesional pressure ratio (TLPR) representing fractional flow reserve (FFR) has been increasingly utilized for hemodynamic and functional assessments of the moderate coronary stenosis in percutaneous coronary intervention (PCI) with an attempt to overcome angiographic limitations (14–21).…”