title: Translesional pressure ratio predicts technical outcome and patency in angioplasty on outflow stenosis of hemodialysis graft.
abstract: OBJECTIVE
  Translesional pressure ratio (TLPR) indicating fractional flow reserve has been applied to physiological assessment of moderate coronary stenosis. The role of TLPR in hemodialysis (HD) patients with arteriovenous graft (AVG) outflow stenosis undergoing percutaneous transluminal angioplasty (PTA) is unclear. The purpose of the study was to assess the validation of TLPR in such patients undergoing PTA.
  
  
  METHODS
  Patients with pure AVG outflow stenosis confirmed by angiography were prospectively enrolled. A TLPR defined as a ratio of the mean pressure downstream to the lesion(s) to the vein-sided intragraft pressure was measured using a catheter pullback method. Relationship among TLPR, angiographic result and clinical outcome within 6 months was detected.
  
  
  RESULTS
  Of 65 PTAs, the post-PTA TLPR significantly increased (from 0.28±0.10 to 0.50±0.11; p<0.0001). A significantly greater pre-PTA TLPR was observed in the simple lesions at baseline compared with the complex lesions (0.32±0.09 vs. 0.20±0.06; p<0.0001). Post-PTA TLPR ≥0.5 was powerfully related to angiographic success (p<0.0001). The group with angiographic success plus post-PTA TLPR ≥0.5 had a longer PTA-free patency (208.7±188.7 vs. 109.8±67.7 days; p=0.013) compared with that with angiographic nonsuccess plus post-PTA TLPR <0.5.
  
  
  CONCLUSIONS
  Our data show that TLPR correlates well with lesion properties and angiographic results, and helps predict following unassisted patency. The study suggests TLPR as a hemodynamic indicator during PTA.
authors.affiliation: 3 School of Medicine, National Yang-Ming University, Taipei - Taiwan.
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Lai
authors.forename: Hua-Chang
authors.initials: HC
authors.lastname: Fang
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
authors.forename: Jau-Cheng
authors.initials: JC
authors.lastname: Liou
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001794:Blood Pressure; D001795:Blood Pressure Determination; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency