TY - JOUR
T1 - Mechanisms of angioplasty in hemodialysis fistula stenoses evaluated by intravascular ultrasound
AU - Davidson, Charles J.
AU - Newman, Glenn E.
AU - Sheikh, Khalid H.
AU - Kisslo, Katherine
AU - Stack, Richard S.
AU - Schwab, Steve J.
N1 - Funding Information:
This study was supported in part by a grant from the Baxter
PY - 1991/7
Y1 - 1991/7
N2 - Mechanisms of angioplasty in hemodialysis fistula stenoses evaluated by travascular ultrasound. Quantification of luminal dimensions and the mechanisms by which angioplasty (PTA) corrects non-atheroma venous stula stenoses have been poorly studied. In 38 consecutive percutaeous balloon angioplasties of hemodialysis fistula stenoses, catheterbased, mechanically-rotated intravascular ultrasound (IVUS) images were obtained along with cineangiography. Images from 24 brachial vein, 11 central vein, 2 graft anastomoses, and 1 brachial artery were quantitatively and qualitatively evaluated. Semiautomated quantitative angiographic stenosis was 64 ± 13% pre-PTA and reduced to 36 ± 19% post-PTA (P < 0.001). Post-PTA IVUS minimal lesion diameter and cross sectional area were 5.7 ± 1.5 mm and 2.9 ± 1.5 mm2, respectively. With IVUS, mechanisms observed were: vessel dissection in 16 42%), arterial stretch (defined as vessel diameter : balloon diameter raotio = 0.75 to 1.0) in 19 (50%), and elastic recoil (defined as vessel diameter : balloon diameter ratio < 0.75) in 19 (50%). Compared to angiography, morphologic information provided by IVUS were plaque composition (hard 11%, soft 89%), plaque topography (eccentric 94%, concentric 6%), thrombus (IVUS: N = 6 vs. angio: N = 1), dissection IVUS: N = 16 vs. angio: N = 1). Thus, IVUS can evaluate lesion morphology and define luminal dimensions after angioplasty. Mechamisms of successful angioplasty of hemodialysis fistula stenosis occur primarily by vessel stretching and dissection, and significant post-PTA narrowing is due to elastic recoil.
AB - Mechanisms of angioplasty in hemodialysis fistula stenoses evaluated by travascular ultrasound. Quantification of luminal dimensions and the mechanisms by which angioplasty (PTA) corrects non-atheroma venous stula stenoses have been poorly studied. In 38 consecutive percutaeous balloon angioplasties of hemodialysis fistula stenoses, catheterbased, mechanically-rotated intravascular ultrasound (IVUS) images were obtained along with cineangiography. Images from 24 brachial vein, 11 central vein, 2 graft anastomoses, and 1 brachial artery were quantitatively and qualitatively evaluated. Semiautomated quantitative angiographic stenosis was 64 ± 13% pre-PTA and reduced to 36 ± 19% post-PTA (P < 0.001). Post-PTA IVUS minimal lesion diameter and cross sectional area were 5.7 ± 1.5 mm and 2.9 ± 1.5 mm2, respectively. With IVUS, mechanisms observed were: vessel dissection in 16 42%), arterial stretch (defined as vessel diameter : balloon diameter raotio = 0.75 to 1.0) in 19 (50%), and elastic recoil (defined as vessel diameter : balloon diameter ratio < 0.75) in 19 (50%). Compared to angiography, morphologic information provided by IVUS were plaque composition (hard 11%, soft 89%), plaque topography (eccentric 94%, concentric 6%), thrombus (IVUS: N = 6 vs. angio: N = 1), dissection IVUS: N = 16 vs. angio: N = 1). Thus, IVUS can evaluate lesion morphology and define luminal dimensions after angioplasty. Mechamisms of successful angioplasty of hemodialysis fistula stenosis occur primarily by vessel stretching and dissection, and significant post-PTA narrowing is due to elastic recoil.
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U2 - 10.1038/ki.1991.185
DO - 10.1038/ki.1991.185
M3 - Article
C2 - 1833583
AN - SCOPUS:0025879505
SN - 0085-2538
VL - 40
SP - 91
EP - 95
JO - Kidney International
JF - Kidney International
IS - 1
ER -