TY - JOUR
TI - VOLume flow assistance for optimizing outcomes of dysfunctional
autologous arteriovenous fistula Angioplasty: the VOLA Pilot Study
AU - Spiliopoulos, Stavros
AU - Giannikouris, Ioannis E.
AU - Katsanos,
AU - Konstantinos
AU - Filippou, Panagiotis
AU - Efthymiou, Evgenia
AU - Reppas,
AU - Lazaros
AU - Kitrou, Panagiotis
AU - Palialexis, Konstantinos and
AU - Filippiadis, Dimitrios
AU - Brountzos, Elias
JO - European Radiology
PY - 2022
VL - 32
TODO - 1
SP - 368-376
PB - Springer-Verlag
SN - 0938-7994, 1432-1084
TODO - 10.1007/s00330-021-08139-7
TODO - Angioplasty; balloon; Arteriovenous fistula; Ultrasonography; Doppler
TODO - 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.
ER -