VOLume flow assistance for optimizing outcomes of dysfunctional autologous arteriovenous fistula Angioplasty: the VOLA Pilot Study

Spiliopoulos, Stavros Giannikouris, Ioannis E. Katsanos, Konstantinos Filippou, Panagiotis Efthymiou, Evgenia Reppas, Lazaros Kitrou, Panagiotis Palialexis, Konstantinos and Filippiadis, Dimitrios Brountzos, Elias

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. (EN)

scientific_publication_article

Επιστημονική δημοσίευση - Άρθρο Περιοδικού (EL)

Scientific publication - Journal Article (EN)

Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών

Πέργαμος

Άρθρο Περιοδικού (Journal Article)

Αγγλική γλώσσα

2022-01-01

uoadl:3029574

https://pergamos.lib.uoa.gr/uoa/dl/object/uoadl:3029574