New hemodynamic test for assessment of failing hemodialysis grafts: the saline infusion test.
OBJECTIVE
To validate the saline infusion test, a new hemodynamic test for assessment of failing hemodialysis access grafts.


METHODS
Over a 12-month period, 31 procedures were performed in 25 patients with synthetic forearm loop grafts for hemodialysis. Pre- and postangioplasty measurements of static graft pressures and infusion pressures were obtained. For the saline infusion test, graft pressure was measured while saline was infused at a rate of 600 mL/min for 10 seconds with arterial inflow occluded. Comparison was made to percent outflow stenosis as determined with pre- and postangioplasty angiograms.


RESULTS
There was no correlation between either the static intragraft pressure (r = .085, P = .654) or the normalized pressure ratio (r = .136, P = .4676) and venous outflow stenosis in the preangioplasty group. When pressure was measured during infusion, a significant Pearson correlation was observed between infusion pressure and percent of angiographic stenosis (r = .60, P = .0002). All three pressure tests were significantly correlated to the percent stenosis identified after angioplasty.


CONCLUSIONS
Pressure measured in the graft during the saline infusion test at a standard rate that simulates optimal graft flow correlates with the angiographic degree of stenosis and warrants further investigation as a useful adjunct to the assessment of revascularization results.
Werdick
G M
GM
Department of Radiology, University of Minnesota School of Medicine, Minneapolis 55455, USA. werdi002@tc.umn.edu
Kruse
J R
JR
Cragg
A H
AH
D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis; D012965:Sodium Chloride
D012965:Sodium Chloride; D011138:Polytetrafluoroethylene