Intragraft pressures predict outcomes in hemodialysis patients with graft outflow lesions undergoing percutaneous transluminal angioplasty.

OBJECTIVES

This study is to introduce intragraft pressure (IGP) as intraprocedural parameter for outcome survey in hemodialysis patients with graft outflow lesions undergoing percutaneous transluminal angioplasty (PTA).

BACKGROUND

The role of IGP on procedural endpoint and patency is unknown.

METHODS

Seventy-five participants with graft outflow lesions receiving PTA were enrolled. Procedural data regarding IGP and angiographic findings were collected and the 1-year graft patency through collaboration with hemodialysis units. Analyses and comparisons among IGP, angiographic findings, and patency were conducted. Using the receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis, we intended to detect significance and the cut-off points of IGP for patency prediction, and difference in patency between the two groups divided by using the cut-off points.

RESULTS

Pre-PTA and post-PTA IGP were significantly associated with 1-year patency (both significance <0.01) with 0.756 and 0.791 areas under the ROC curves, respectively. The cut-off points of pre-PTA and post-PTA IGP were closer to 106 and 47 mm Hg for prediction of 1-year patency (sensitivity = 0.76, specificity = 0.69; sensitivity = 0.79, specificity = 0.69, respectively; 95% CI). Significant reductions in 1-year patency were shown in the subjects with greater than the cut-off values, either pre-PTA or post-PTA IGP, compared with those with smaller than these values (both log rank test < 0.001).

CONCLUSION

IGP might be useful to evaluate procedural endpoints and predict patency outcomes in hemodialysis patients with graft outflow lesions undergoing PTA. Patients with the greater pre-PTA or post-PTA IGP, to some level, seem to have the shorter patency.