title: Intragraft pressures predict outcomes in hemodialysis patients with graft outflow lesions undergoing percutaneous transluminal angioplasty.
abstract: OBJECTIVE
  This study is to introduce intragraft pressure (IGP) as intraprocedural parameter for outcome survey in hemodialysis patients with graft outflow lesions undergoing percutaneous transluminal angioplasty (PTA).
  
  
  BACKGROUND
  The role of IGP on procedural endpoint and patency is unknown.
  
  
  METHODS
  Seventy-five participants with graft outflow lesions receiving PTA were enrolled. Procedural data regarding IGP and angiographic findings were collected and the 1-year graft patency through collaboration with hemodialysis units. Analyses and comparisons among IGP, angiographic findings, and patency were conducted. Using the receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis, we intended to detect significance and the cut-off points of IGP for patency prediction, and difference in patency between the two groups divided by using the cut-off points.
  
  
  RESULTS
  Pre-PTA and post-PTA IGP were significantly associated with 1-year patency (both significance <0.01) with 0.756 and 0.791 areas under the ROC curves, respectively. The cut-off points of pre-PTA and post-PTA IGP were closer to 106 and 47 mm Hg for prediction of 1-year patency (sensitivity = 0.76, specificity = 0.69; sensitivity = 0.79, specificity = 0.69, respectively; 95% CI). Significant reductions in 1-year patency were shown in the subjects with greater than the cut-off values, either pre-PTA or post-PTA IGP, compared with those with smaller than these values (both log rank test < 0.001).
  
  
  CONCLUSIONS
  IGP might be useful to evaluate procedural endpoints and predict patency outcomes in hemodialysis patients with graft outflow lesions undergoing PTA. Patients with the greater pre-PTA or post-PTA IGP, to some level, seem to have the shorter patency.
authors.affiliation: Cardiovascular Center, Kaohsiung Veterans General Hospital, #386 Ta-Chung 1st Road, Taiwan, Republic of China.
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Lai
authors.forename: Hsiao-Min
authors.initials: HM
authors.lastname: Chung
authors.forename: Han-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Guang-Yuan
authors.initials: GY
authors.lastname: Mar
authors.forename: Ching-Jiunn
authors.initials: CJ
authors.lastname: Tseng
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011859:Radiography; D012039:Regional Blood Flow; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency