Kumbar L, Peterson E, Zaborowicz M, Besarab A, Yee J, and Zasuwa G. Sentinel Vascular Access Monitoring After Endovascular Intervention Predicts Access Outcome. J Vasc Access 2019; 20(4):409-416.
J Vasc Access
BACKGROUND AND OBJECTIVES: The vascular access pressure ratio test identifies dialysis vascular access dysfunction when three consecutive vascular access pressure ratios are >0.55. We tested whether the magnitude of the decline in vascular access pressure ratio 1-week post-intervention could alert of subsequent access failure.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The retrospective study included all vascular access procedures at one institution from March 2014 to June 2016. Data included demographics, comorbidities, vascular access features, %ΔVAPR = ((Pre-Post)/Pre] × 100% assessed within the first 2 weeks post-percutaneous transluminal balloon angioplasty, time-to-next procedure, and patency. The log-rank test compared the area under the curve, receiver operating curve, Kaplan-Meier arteriovenous graft and arteriovenous fistula survival curves. A multivariable Cox proportional hazard (CP) model was used to determine the association of %ΔVAPR with access patency.
RESULTS: Analysis of 138 subjects (females 51%; Black 87%) included 64 arteriovenous fistulas with 104 angioplasties and 74 arteriovenous grafts with 134 angioplasties. The area under the receiver operating characteristic curve for fistula failure at 3 months was 0.59, with optimal screening characteristics of 33.3%, sensitivity of 56.1%, and specificity of 63.2%. Arteriovenous fistula with33.3% required earlier subsequent procedure (136 vs 231 days), lower survival on Kaplan-Meier analysis (P = 0.01), and twofold greater risk of failure (P = .006). Area under the receiver operating characteristic for arteriovenous graft failure at 3 months had a sensitivity of 52.3% and specificity of 67.4%. Arteriovenous graft with a post-intervention vascular access pressure ratio decline of
CONCLUSION: The magnitude of post-intervention reduction in vascular access pressure ratio provides a novel predictive measure of access outcomes.
Medical Subject Headings
Aged; Algorithms; Angioplasty, Balloon; Arterial Pressure; Arteriovenous Shunt, Surgical; Blood Pressure Determination; Blood Vessel Prosthesis Implantation; Female; Graft Occlusion, Vascular; Humans; Kidney Failure, Chronic; Male; Middle Aged; Predictive Value of Tests; Renal Dialysis; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency; Venous Pressure