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 |
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Abstract |
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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