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SIMPLE PRESSURE MEASUREMENT IS NOT RELIABLE IN DETECTION OF ACCESS STENOSIS IN NATIVE AV FISTULAS
Author(s) -
Portová M.,
Hor̆ení J.,
Kr̆emenová E.,
Nejedlý B.,
Válek M.,
Lopot F.
Publication year - 2005
Publication title -
edtna‐erca journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.381
H-Index - 27
eISSN - 1755-6686
pISSN - 1019-083X
DOI - 10.1111/j.1755-6686.2005.tb00412.x
Subject(s) - medicine , stenosis , angioplasty , balloon , cardiology , forearm , nuclear medicine , surgery , radiology
SUMMARY Dynamic arterial and venous pressures (PA, PV) are used as the simplest tools to assess vascular access quality (VAQ). An increased PV over three consecutive dialyses is believed to indicate a stenosis, a rule devised for synthetic grafts (AVG) but not adequately validated for AV fistulas (AVF). In this study dynamic PV and static intra‐access pressure (calculated by means of the simplified formula PIA=(PA+PV)/2) changes were evaluated in 46 accesses in which balloon angioplasty had to eventually be performed. The whole group consisted of 30 forearm AVF, 5 upper arm AVF and 11 AVG. Pressures were compared in each patient at a time of satisfactory access flow (QVA) and immediately before the angioplasty and pressure difference over that period (ΔPV, ΔPIA) evaluated. Despite a significant drop in QVA over the follow‐up interval in both AVF and AVG, the mean ΔPV and ΔPIA in AVF were only several mm Hg and the chosen threshold limit of 20 mmHg was exceeded in approximately 10% of patients only. The results in the AVG group were, however, very different: The mean ΔPV and ΔPIA were close to 20 mmHg and almost 60% of patients in the AVG group exceeded this limit. Evaluation of PIA did not improve stenosis detection in either group. It is concluded that PV and/or PIA monitoring may be useful to detect a stenosis in AVG but not in AVF.