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KMID : 0359920080270060696
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Korean Journal of Nephrology
2008 Volume.27 No. 6 p.696 ~ p.706
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Early Detection of Hemodialysis Ateriovenous Fistula Dysfunction by Trend Analysis of Intra-access Pressure
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Ahn Hyung-Jun
Lee Jong-Hoon
Park Sung-Il
Yoon Soo-Young
Lee Sang-Choel
Yang Sung-Ja
Kim Yu-Seun
Park Ki-Il
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Abstract
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Purpose: To detect early arteriovenous fistula (AVF) dysfunction, we have developed a new method of intra-access total pressure (pT), and static pressure (pS) measurements. The purpose of this studyn is to assess the relationship between intra-access pressure and vascular stricture in order to establish the clinical validity of the method.
Methods: Total 46 of native AVFs were enrolled. They were measured intra-access pS and pT monthly. In initial angiography, 6 of 10 inflow stricture (As), 6 of 7 outflow stricture (Vs) and 2 having both lesions were taken PTA (percutaneous angioplasty) and compared pressure and ratio changes. If △p (pT-pS) decreased more than 10% over 3 months or pT/MAP (mean arterial pressure) ratio dropped more than 10% over 3 months with below 0.8, then the patients were referred to angiography. Thirtyone patients were performed final angiography, and we compared the results with those of initial angiography.
Results: Although pT/MAP ratio and △p were increased after PTA, there was no statistical significance in 6 As (+) patients (p>0.05). Six Vs (+) and 2 AS (+) and Vs (+) patients’ △p were increased significantly (p<0.05). Two As (+) and 5 Vs (+) were detected with △p or pT/MAP ratio change. However, 2 Vs (+) were unable to be detected with △p, but detected only by final angiography. Among 15 As (-) and Vs (-) patients in both initial and final angiography, pT and MAP were not reproducible (pI<0.4), but pS and △p showed intermediate reproducibility (pI>0.45).
Conclusion: Intra-access stricture could be detected with pT/MAP ratio and △p change. However, more careful MAP and pT measurement should be recommended for accurate diagnosis.
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KEYWORD
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Arteriovenous fistula, Vascular stricture, Pressure, Angiography
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