Short- and long-term functional effects of percutaneous transluminal angioplasty in hemodialysis vascular access.
The efficacy of percutaneous transluminal angioplasty (PTA) is usually expressed as the angiographic result. Access flow (Qa) measurements offer a means to quantify the functional effects. This study was performed to evaluate the short-term functional and angiographic effects of PTA and to determine the longevity of the functional effects during the follow-up period. Patients with an arteriovenous graft (AVG) or an arteriovenous fistula (AVF) who were eligible for PTA (Qa values of <600 ml/min) were included. Ultrasound-dilution Qa measurements were obtained shortly before PTA and periodically after PTA, beginning 1 wk after the procedure. The short-term effects were expressed as the increase in Qa and the reduction of stenosis. The long-term effects were expressed as patency and the decrease in Qa after PTA. Ninety-eight PTA procedures for 60 patients (65 AVG and 33 AVF) were analyzed. Qa improved from 371 +/- 17 to 674 +/- 30 ml/min for AVG and from 304 +/- 24 to 638 +/- 51 ml/min for AVF (both P < 0.0001). In 66% (AVG) and 50% (AVF) of cases, Qa increased to levels of >600 ml/min. The degree of stenosis decreased from 65 +/- 3 to 17 +/- 2% for AVG and from 72 +/- 5 to 23 +/- 7% for AVF (both P < 0.005). The reduction of stenosis was not correlated with DeltaQa (r(2) = 0.066). Six-month unassisted patency rates after PTA were 25% for AVG and 50% for AVF. The decreases in Qa were 3.7 +/- 0.8 ml/min per d for AVG and 1.8 +/- 0.9 ml/min per d for AVF. Qa values before PTA and DeltaQa were correlated with the subsequent decrease in Qa (P < 0.005). In conclusion, Qa increases after PTA but, in a substantial percentage of cases, not to levels of >600 ml/min. Qa values before PTA and the increase in Qa were correlated with long-term outcomes, whereas angiographic results were not. These data, combined with literature data, suggest that there is optimal timing for PTA.
van der Linden
Joke
J
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Smits
Johannes H M
JHM
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Assink
Jan H
JH
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Wolterbeek
Derk W
DW
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Zijlstra
Jan J
JJ
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
de Jong
Gijs H T
GHT
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
van den Dorpel
Marinus A
MA
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Blankestijn
Peter J
PJ
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome