The effect of angioplasty of single arteriovenous fistula–associated stenosis on arteriovenous fistula blood flow rate

Nassar, George M.; Beathard, Gerald A.; Nguyen, Duc T.; Graviss, Edward A.

doi:10.1177/1129729819901223

Cited by 6 publications

(6 citation statements)

References 22 publications

(45 reference statements)

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“…The stenosis MLD was calculated as previously described. 13 The estimation of stenosis and diameter were performed at the time of the procedure by the operator. These measurements were derived using the angioplasty balloon length and diameter as the reference metric.…”

Section: Angioplasty and Procedural Characteristicsmentioning

confidence: 99%

Lumen diameter is associated with the patency after percutaneous angioplasty of arteriovenous fistulas

Hao

Huang

et al. 2022

J Vasc Access

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Aim: To assess the value of lumen diameter after percutaneous angioplasty (PTA) to predict functional dialysis use (FDU) of arteriovenous fistulas (AVF). Methods: We performed a retrospective study of all patients who underwent first PTA because of AVF stenosis between March 2019 and March 2021. The outcome was FDU of AVF at 6 months follow up. Independent factors of FDU were identified using multivariate regression analyses. Receiver operating characteristic (ROC) curve was performed to investigate the predictive ability of lumen diameter for FDU. Results: A total 68 patients were included into this study and the AVF of 53 cases (77.9%) were good for FDU after 6 months. The AVF age was younger in failure group than that in success group (16.1 ± 9.1 months vs 28.3 ± 20.0 months, p = 0.026). Compared with failure group, the post-PTA minimum luminal diameter (MLD) was bigger in success group (4.5 [4.0–4.5 mm] vs 5.5 mm [4.5–5.5 mm], p < 0.001). Meanwhile, the gain of lumen diameter in success group was also bigger than that in failure group (2.5 mm [2.0–3.0 mm] in failure group vs 3.0 mm [2.75–3.5 mm] in success group, p = 0.012). The residual stenosis was higher in failure group than that in success group (30% [10%–40%] vs 10% [0%−20%], p = 0.003). Logistic regression showed that AVF age and post-PTA MLD were independent predictors of FDU. ROC analysis showed that the gain of lumen diameter, post-PTA MLD and improvement of stenosis were comparable to predict FDU. For post-PTA MLD, the area under ROC curve was 0.804 (95% CI, 0.681–0.927, p < 0.001). The best cutoff is 4.75 mm, with the sensitivity and specificity was 71.7% and 80.0%, respectively. Conclusions: AVF age and post-PTA MLD were independently predictors for FDU of AVF after PTA. To get the best performance, a minimum vein diameter of 4.75 mm should be obtained after angioplasty.

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Section: Angioplasty and Procedural Characteristicsmentioning

confidence: 99%

Lumen diameter is associated with the patency after percutaneous angioplasty of arteriovenous fistulas

Hao

Huang

et al. 2022

J Vasc Access

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“…[18] Another study reported that both vascular access flow volume and cardiac output were increased by PTA in most cases, whereas in some cases, the cardiac output decreased despite an increase in vascular access flow volume. [19] Beyond its association with cardiac output, baseline VABF serves as the most reliable predictor for changes in VABF [20] The diversity in study characteristics and variations in methodologies and temporal parameters for measuring VABF and cardiac output make it challenging to draw definitive conclusions. Regardless of whether cardiac output increased after PTA, these studies and our findings suggest the necessity of shifting the perspective from the physiological response of the vascular circuit to localized microvascular dysfunction to investigate progressive increases in vascular access flow after PTA.…”

Section: Discussionmentioning

confidence: 99%

“…Stenosis minimum luminal diameter cutoffs of ≤ 2.0 and > 4.5 mm are valuable in forecasting the extent of changes in VABF. [20] The diversity in study characteristics and variations in methodologies and temporal parameters for measuring VABF and cardiac output make it challenging to draw definitive conclusions. Regardless of whether cardiac output increased after PTA, these studies and our findings suggest the necessity of shifting the perspective from the physiological response of the vascular circuit to localized microvascular dysfunction to investigate progressive increases in vascular access flow after PTA.…”

Section: Discussionmentioning

confidence: 99%

Progressive increase in vascular access blood flow after percutaneous transluminal angioplasty in patients on hemodialysis

Koh,

Kim,

Lee

2024

Medicine

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Percutaneous transluminal angioplasty (PTA) is the gold standard for treating stenoses with dysfunctional vascular access. Recently, we found that vascular access blood flow (VABF) measured immediately after PTA increased over time without the need for additional procedures in the patients who underwent PTA. Therefore, this study was conducted to confirm an increase in VABF after PTA and identify the factors associated with it. Patients on chronic hemodialysis at a single institution were retrospectively reviewed and those with accesses that had a measurement of VABF immediately after PTA and within 1 month from PTA were included in the study. The relationship between clinical parameters and changes in VABF were analyzed using paired t-test and linear regression. A total of 47 PTA accesses (fistulas, 26; grafts,21) were included. The mean VABF on the day of PTA and the following measurement were 796.9 ± 329.1 mL/min and 1105.1 ± 410.3 mL/min, respectively. In the univariate analysis, the diameter of the balloon catheter used in the PTA and serum uric acid (SUA) level were significantly associated with an increase in VABF. Atrial fibrillation was a significant factor for the percentage change in vascular access. In the multivariate analysis, SUA level, balloon catheter diameter, and atrial fibrillation remained independent factors for changes in VABF and percentage change in VABF, respectively. The study identified progressive increases in the VABF after PTA without additional procedures. SUA level, balloon catheter diameter used in PTA, and atrial fibrillation were independently associated with changes in VABF.

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“…In the report by Nassar et al, MLD ≤2 mm and ˃4.5 mm before PTA were associated with an increase in VF after PTA of ≥300 mL/min and <300 mL/min, respectively. They reported that stenosis MLD ≤2.0 and >4.5 mm were useful in predicting the magnitude of changes in VF (17). In another similar report, MLD was reported to have a weak positive correlation with VF, but an MLD cutoff of ≤2.5 mm had a good predictive value in detecting VF <500 mL/min (18).…”

Section: Discussionmentioning

confidence: 99%

Association of radiocephalic arteriovenous anatomical markers with post-angioplasty blood flow volume

Tanyeri

2024

Acta Radiol

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Background Doppler ultrasound (DUS) blood volume flow (VF) calculation is the most reliable method for demonstrating the success of endovascular treatment of dysfunctional radiocephalic arteriovenous fistula (AVF). Due to the difficulty of this method for the interventionalist, VF-correlated markers are required during the procedure. Purpose To investigate the relationship between intraprocedural anatomical markers (AMs) and changes in VF induced by percutaneous transluminal angioplasty (PTA). Material and Methods The study included 56 patients with dysfunctional radiocephalic AVF who underwent PTA between September 2020 and 2022. The VF of all patients was measured using DUS before and 1 h after PTA. AMs were determined from 10 images, five before and five after balloon angioplasty. Results The mean post-PTA VF was 637 ± 277 mL/min compared to baseline (151 ± 107 mL/min). Before and after balloon angioplasty, vein diameter (VD), artery diameter (AD), stenosis minimum luminal diameter (MLD), stenosis percentage (SP), and VF values were statistically significant ( P = 0.001). Spearman’s correlation analysis showed a positive strong linear relationship between VF and MLD ( rs = 0.850, P <0.001), and a negative strong linear relationship between VF and SP ( rs = 0.815). Receiver operating characteristic curve analysis showed that the sensitivity and specificity for VF ≥400 mL/min at cutoffs of SP <50% and MLD >2.5 mm were 81% and 82%, and 81% and 90%, respectively. Conclusion Among the AMs readily available during PTA, first MLD and then SP provided satisfactory results in predicting VF.

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The effect of angioplasty of single arteriovenous fistula–associated stenosis on arteriovenous fistula blood flow rate

Cited by 6 publications

References 22 publications

Lumen diameter is associated with the patency after percutaneous angioplasty of arteriovenous fistulas

Lumen diameter is associated with the patency after percutaneous angioplasty of arteriovenous fistulas

Progressive increase in vascular access blood flow after percutaneous transluminal angioplasty in patients on hemodialysis

Association of radiocephalic arteriovenous anatomical markers with post-angioplasty blood flow volume

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