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

Lai, Chi-Cheng; Fang, Hua‐Chang; Tsai, Han-Lin; Mar, Guang-Yuan; Tseng, Ching‐Jiunn; Liu, Chun–Peng; Liou, Jyh‐Ming

doi:10.5301/jva.5000184

Cited by 1 publication

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“…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.…”

Section: Introductionmentioning

confidence: 99%

Sentinel vascular access monitoring after endovascular intervention predicts access outcome

et al. 2018

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Background and objectives: The vascular access pressure ratio test identifies dialysis vascular access dysfunction when three consecutive vascular access pressure ratios are >0.55. We tested whether the magnitude of the decline in vascular access pressure ratio 1-week post-intervention could alert of subsequent access failure. Design, setting, participants, and measurements: The retrospective study included all vascular access procedures at one institution from March 2014 to June 2016. Data included demographics, comorbidities, vascular access features, %ΔVAPR = ((Pre-Post)/Pre] × 100% assessed within the first 2 weeks post-percutaneous transluminal balloon angioplasty, time-to-next procedure, and patency. The log-rank test compared the area under the curve, receiver operating curve, Kaplan-Meier arteriovenous graft and arteriovenous fistula survival curves. A multivariable Cox proportional hazard (CP) model was used to determine the association of %ΔVAPR with access patency. Results: Analysis of 138 subjects (females 51%; Black 87%) included 64 arteriovenous fistulas with 104 angioplasties and 74 arteriovenous grafts with 134 angioplasties. The area under the receiver operating characteristic curve for fistula failure at 3 months was 0.59, with optimal screening characteristics of 33.3%, sensitivity of 56.1%, and specificity of 63.2%. Arteriovenous fistula with <33.3% decline compared to >33.3% required earlier subsequent procedure (136 vs 231 days), lower survival on Kaplan-Meier analysis (P = 0.01), and twofold greater risk of failure (P = .006). Area under the receiver operating characteristic for arteriovenous graft failure at 3 months had a sensitivity of 52.3% and specificity of 67.4%. Arteriovenous graft with a post-intervention vascular access pressure ratio decline of <28.8% also required earlier subsequent procedure (144 vs 189 days), lower survival on Kaplan-Meier (P = 0.04), and a 59% higher risk for failure. The area under the receiver operating characteristic curve for combined access failure (arteriovenous fistula + arteriovenous graft) at 3 months had an optimal cut-point value of 31.2%, a sensitivity of 54.6%, and a specificity of 63.1%. Access with a <31.2% drop had a 62% increase in the risk of failure (hazard ratio 1.62; confidence interval 1.16, 2.27; P = 0.005). Conclusion: The magnitude of post-intervention reduction in vascular access pressure ratio provides a novel predictive measure of access outcomes.

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Section: Introductionmentioning

confidence: 99%

Sentinel vascular access monitoring after endovascular intervention predicts access outcome

et al. 2018

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

Abstract: Our data show that TLPR correlates well with lesion properties and angiographic results, and helps predict following unassisted patency. The study suggests TLPR as a hemodynamic indicator during PTA.

Cited by 1 publication

References 25 publications

Sentinel vascular access monitoring after endovascular intervention predicts access outcome

Sentinel vascular access monitoring after endovascular intervention predicts access outcome

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