The Role of Postintervention Pullback Pressure Gradient in Percutaneous Transluminal Angioplasty for Central Vein Stenosis in Dialysis Patients

Abstract

The severity of residual stenosis (RS) sometimes cannot be accurately measured by angiography during central vein intervention. This study evaluated the role of pullback pressure measurement during central vein stenosis (CVS) intervention. A retrospective review enrolled 94 consecutive dialysis patients who underwent CVS interventions but not stenting procedures. Patients were classified into 2 groups by either angiography or pressure gradient (PG) criteria, respectively. Groups divided by angiographic result were successful group (RS ≤ 30 %) and acceptable group (50 % ≥ RS > 30 %), while groups divided by PG were low PG group (PG ≤ 5 mmHg) and high PG group (PG >5 mmHg). Baseline characteristics and 12-month patency rates between the groups were analyzed. The angiography results placed 63 patients in the successful group and 31 patients in the acceptable group. The patency rate at 12 month was not statistically different (P = 0.167). When the patients were reclassified by the postintervention pullback PG, the patency rate at 12 months was significant (P = 0.048). Further analysis in groups redivided by different combinations of RS and PG criteria identified significant differences in the group with both RS ≤ 30 % and PG ≤ 5 mmHg compared with those with either RS >30 % (P = 0.047) or PG >5 mmHg (P = 0.027). In addition, there was a significant difference between those with both RS ≤ 30 % and PG ≤ 5 mmHg compared with those with both RS >30 % and PG >5 mmHg (P = 0.027). Postintervention PG can better predict long-term outcomes after angioplasty for CVS in nonstented dialysis patients than angiography.