Flow in hemodialysis grafts after angioplasty: Do radiologic criteria predict success?
BACKGROUND
The anatomic success of percutaneous angioplasty of venous stenosis is determined by the improvement in cross-sectional diameter of the vessel. A successful outcome is defined as a residual stenosis of <30%. The purpose of this study was to determine whether the angiographic assessment of a venous stenosis correlates with the change in graft blood flow following angioplasty.


METHODS
Twenty-two hemodialysis patients with decreased intragraft blood flow (<700 mL/min) underwent diagnostic fistulography and angioplasty. All grafts were patent at the time of the procedure. Intragraft blood flow was measured before and after angioplasty using the ultrasonic dilution technique. Change in graft blood flow after angioplasty was correlated to the morphologic changes of the treated stenosis.


RESULTS
The mean preangioplasty and postangioplasty graft blood flows were 457 +/- 136 and 818 +/- 202 mL/min, respectively. The mean degree of stenosis before angioplasty was 74 +/- 15% and 18 +/- 14% after dilation (P < 0.001). The only variable that significantly correlated with postangioplasty blood flow was preangioplasty flow (r2 = 0.22, P < 0.001). The postangioplasty blood flow was not significantly different than the highest recorded blood flow measured in that graft (798 +/- 213 mL/min, P = NS). There was no significant correlation between the change in blood flow and the change in percentage of stenosis.


CONCLUSIONS
Following angioplasty of a venous stenosis, the graft blood flow is most closely predicted by the preprocedural blood flow and is similar to the highest recorded blood flow ever measured in that graft. Angiographic criteria to assess the success of angioplasty are not predictive of changes in blood flow.
Ahya
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Renal Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Windus
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Vesely
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D000368:Aged; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D002408:Catheters, Indwelling; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014680:Veins / Q000473:pathology / Q000503:physiopathology