@article{3029574,
    title = "VOLume flow assistance for optimizing outcomes of dysfunctional
autologous arteriovenous fistula Angioplasty: the VOLA Pilot Study",
    author = "Spiliopoulos, Stavros and Giannikouris, Ioannis E. and Katsanos, and Konstantinos and Filippou, Panagiotis and Efthymiou, Evgenia and Reppas, and Lazaros and Kitrou, Panagiotis and Palialexis, Konstantinos and and Filippiadis, Dimitrios and Brountzos, Elias",
    journal = "European Radiology",
    year = "2022",
    volume = "32",
    number = "1",
    pages = "368-376",
    publisher = "Springer-Verlag",
    issn = "0938-7994, 1432-1084",
    doi = "10.1007/s00330-021-08139-7",
    keywords = "Angioplasty; balloon; Arteriovenous fistula; Ultrasonography; Doppler",
    abstract = "Objectives To investigate the feasibility of VF-assisted angioplasty
(VFA) in dysfunctional AVF using sequential intraprocedural duplex
ultrasound (DUS), to utilize intraprocedural VF as a quantifiable,
functional endpoint in endovascular treatment. Methods This prospective
study included 20 consecutive patients (23 lesions; 16 men; mean age 67
+/- 16 years) with dysfunctional AVF undergoing fluoroscopically guided
balloon angioplasty between June 2019 and May 2020. Primary endpoints
were quantification of outcome using sequential DUS VF analysis
following each dilation, 6-month target lesion re-intervention
(TLR)-free rate, standard technical success, procedural success
(achievement of a postprocedural VF value equal (or 10% less) or
superior to the baseline steady-state access), and correlation between
procedural success and TLR-free rate. Secondary endpoints included
6-month lesion late lumen loss (LLL), correlation between balloon
diameter used and intraprocedural VF values, and correlation between VF
and LLL at 6 months follow-up. Results Mean VF increase was 168.5% +/-
102.5% (range: 24.24-493.33%). Procedural success was 80% (16/20
cases). VFA improved procedural success by 20% (4/20 cases) compared to
standard assessment (< 30% residual stenosis and palpable thrill).
TLR-free rate was 78.3% and 67.3% at 6 and 12 months. Significantly
less TLR was noted in cases of procedural success (82.4% vs. 66.7% 6
months; p = 0.041). Unweighted linear regression showed a significant
positive relationship between diameter of balloon and VF (146.9 +/- 42.3
mL/min VF gain per mm of balloon diameter; p = 0.001, R2 = 0.23) and a
significant negative relationship between LLL and VF decline at
follow-up (102.0 +/- 34.6 mL/min loss per mm of LLL; p = 0.01, R2 =
0.35). Optimal VF cutoff value and percentile increase to predict access
failure were 720 mL/min (sensitivity 58.3%, specificity 71.4%) and
153% (sensitivity 66.7%, specificity 85.7%), respectively. Conclusion
Intraprocedural VF assessment could be used to optimize AVF angioplasty."
}