Original Article : Early Detection of Hemodialysis Arteriovenous Fistula Dysfunction with Intra-access Static and Total Pressure Measurement

Korean Journal of Nephrology 2007;26(1):70-78.

Jong Hoon Lee, M.D.1, Sung Il Park, M.D.2, Soo Young Yoon, M.D.3, Sang Choel Lee, M.D.3 Sung Ja Yang, R.N.3, Hyung Joon Ahn, M.D.4, Yu Seun Kim, M.D.4 and Kiil Park, M.D.1

Departments of Surgery¹
Radiology2 and Nephrology³
Kwandong University College of Medicine Goyang, and Department of Surgery⁴
Yonsei University College of Medicine, Seoul

임상연구 : 혈액투석을 위한 동정맥루 내 정압 및 전압 측정을 통한 기능 부전의 조기 진단

이종훈1

관동대학교 의과대학 외과학교실1, 방사선과학교실2, 내과학교실3, 연세대학교 의과대학 외과학교실4

Abstract

Purpose
To detect the dysfunction of arteriovenous fistula (AVF) early, we have developed a new method to calculate the intra-vascular conduit flow rate based on the Bernoulli`s theory. However, this method has limitation on detection of inflow stenosis. For detection of both in- and out-flow stenosis, we tried to measure intra-access static (pS) and total pressure (pT), and compared with angiographic findings.
Methods
From a total of 46 cases of native AVFs, of at least 3 months of construction, intra-access pS and pT were measured, before starting hemodialysis. Δp (pT-pS) and pT/mean arterial pressure (MAP) ratio were calculated, and compared with angiographic findings.
Results
Among 37 patients without outflow stenosis (Vs) in fistulogram, 10 patients with inflow stenosis (As) had significantly lower pT/MAP ratio and Δp than those without As patients (p<0.005). Among 34 patients without As, Δp was significantly lower in 7 patients with Vs than those 27 patients without Vs (p=0.001).
Conclusion
pT/MAP ratio was correlated with As, and Δp reflects Vs in angiography. The measurement of pS and pT might be useful to predict inflow and outflow stenosis of AVFs. Key words : Arteriovenous fistula, Stenosis, Pressure, Angiography

Key Words: Arteriovenous fistula, Stenosis, Pressure, Angiography