Korean Journal of Nephrology 2008;27(6):696-706.
Early Detection of Hemodialysis Ateriovenous Fistula Dysfunction by Trend Analysis of Intra-access Pressure
Hyung Joon Ahn, M.D.1, 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, Yu Seun Kim, M.D.4 and Kiil Park, M.D.1
Departments of Surgery1
Radiology2 and Nephrology3
Kwandong University College of Medicine, Goyang, Department of Surgery4
Yonsei University College of Medicine, Seoul
임상연구 : 혈액투석을 위한 동정맥루 내 압력의 경향 분석을 이용한 기능부전의 조기 진단
안형준1, 이종훈1, 박성일2, 윤수영3, 이상철3, 양성자3, 김유선4, 박기일1
관동대학교 의과대학 명지병원 외과학교실1, 영상의학과교실2, 내과학교실3, 연세대학교 의과대학 외과학교실4
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 study 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.
Key Words: Arteriovenous fistula, Vascular stricture, Pressure, Angiography

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