The role of postintervention pullback pressure gradient in percutaneous transluminal angioplasty for central vein stenosis in dialysis patients.
OBJECTIVE
The severity of residual stenosis (RS) sometimes cannot be accurately measured by angiography during central vein intervention. This study evaluated the role of pullback pressure measurement during central vein stenosis (CVS) intervention.


METHODS
A retrospective review enrolled 94 consecutive dialysis patients who underwent CVS interventions but not stenting procedures. Patients were classified into 2 groups by either angiography or pressure gradient (PG) criteria, respectively. Groups divided by angiographic result were successful group (RS ≤ 30 %) and acceptable group (50 % ≥ RS > 30 %), while groups divided by PG were low PG group (PG ≤ 5 mmHg) and high PG group (PG >5 mmHg). Baseline characteristics and 12-month patency rates between the groups were analyzed.


RESULTS
The angiography results placed 63 patients in the successful group and 31 patients in the acceptable group. The patency rate at 12 month was not statistically different (P = 0.167). When the patients were reclassified by the postintervention pullback PG, the patency rate at 12 months was significant (P = 0.048). Further analysis in groups redivided by different combinations of RS and PG criteria identified significant differences in the group with both RS ≤ 30 % and PG ≤ 5 mmHg compared with those with either RS >30 % (P = 0.047) or PG >5 mmHg (P = 0.027). In addition, there was a significant difference between those with both RS ≤ 30 % and PG ≤ 5 mmHg compared with those with both RS >30 % and PG >5 mmHg (P = 0.027).


CONCLUSIONS
Postintervention PG can better predict long-term outcomes after angioplasty for CVS in nonstented dialysis patients than angiography.
Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Chang Gung Institute of Technology, 6, Sec. West Chai-Pu Road, Pu-TZ City, Chai Yi Hsien, 61363, Taiwan, ROC, dissertlin@yahoo.com.tw.
Yu-Sheng
YS
Lin
Cheng-Hsu
CH
Yang
Chi-Ming
CM
Chu
Chi-Yung
CY
Fang
Chien-Jen
CJ
Chen
Jen-Te
JT
Hsu
Teng-Yao
TY
Yang
Chi-Ling
CL
Hang
Chiung-Jen
CJ
Wu
D017130:Angioplasty / Q000379:methods*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011859:Radiography; D006435:Renal Dialysis; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016896:Treatment Outcome; D014654:Vascular Patency; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging