New predictive marker for hemodialysis vascular access dysfunction.

Abstract

To examine the relationship between intra-access pressures and vascular stenosis,

we measured the total (pT ) and static (pS ) pressures and the severity of

stenosis before and after percutaneous transluminal angioplasty (PTA). The

dynamic pressure ( big up tri, openp) and static intra-access pressure ratios

(SIAPR) were calculated. We analyzed the clinical correlation of big up tri,

openp and SIAPR with the severity and location of stenosis, and searched

potential predictive factors for the severity of stenosis using multivariate

regression. While SIAPR was significantly decreased only in outflow stenosis

after PTA (p < 0.0001), big up tri, openp was significantly increased in both

inflow and in outflow stenosis (p < 0.05). SIAPR was negatively correlated with

the severity of stenosis only in outflow stenosis (p < 0.0001), and big up tri,

openp was significantly correlated with both inflow and outflow stenosis (p <

0.05). big up tri, openp was an independent predictor for the severity of

stenosis in both inflow and outflow stenosis (p < 0.05). Thus, our study suggests

that big up tri, openp may be more clinically useful than SIAPR not only in

detecting access stenosis regardless of its location, but also providing

information about the severity of stenosis.