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Using Pullback Pressure Measurements to Identify Venous Stenoses Persisting After Successful Angioplasty in Failing Hemodialysis Grafts

¹ Department of Radiology, The University of Chicago Hospitals, MC2026, 5841 S. Maryland Ave., Chicago, IL 60637.
² Racine Radiologist Group, 3803 Spring St., Rm. 208, Racine, WI 53405.

OBJECTIVE. We used pullback pressure measurements to identify venous stenoses persisting after angioplasty of failing hemodialysis grafts.

MATERIALS AND METHODS. Fifty angioplasty procedures were performed in 32 patients with elevated venous pressures at dialysis. Grafts were initially evaluated on digital subtraction angiography, and all stenoses measuring greater than 50% on angiography underwent angioplasty. In successful cases (residual stenosis < 30%), pullback pressure measurements were obtained from the superior vena cava to the graft to identify hemodynamically significant (> 10 mm Hg) stenoses. These lesions were then treated with repeated angioplasty.

RESULTS. Hemodynamically significant stenoses with a gradient range of 10-27 mm Hg (mean, 16 mm Hg) were found in nine (18%) of 50 procedures. All gradients occurred at sites of previous angioplasty. Repeated angioplasty of these stenoses performed with larger angioplasty balloons reduced gradients to less than 3 mm Hg in six stenoses and to 5 mm Hg in three stenoses. In this subgroup, primary patency was eight (89%) of nine stenoses at 1 month and 2 months and five (56%) of nine stenoses at 6 months. Using life table analysis, we found that primary patency of the entire population was 84% at 1 month, 66% at 2 months, and 47% at 6 months. The mean time between interventions was 6 months, and the thrombosis rate was 0.32 per year.

CONCLUSION. Pullback pressure measurements are a useful adjunct to angiography to evaluate the hemodynamic results of angioplasty in patients with failing hemodialysis grafts.

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