Andrew Robert Forauer MD, Presenter: Nothing to Disclose

Eric K. Hoffer MD, Abstract Co-Author: Research Consultant, Guidant Corporation, Minneapolis, MN

Technical variables associated with percutaneous transluminal angioplasty (PTA) include vessel sizing & appropriate balloon selection, inflation pressure, number of inflations, duration of inflation, and use of anticoagulation. We performed a prospective study to examine the role of balloon inflation time on the technical success of PTA in arteriovenous grafts and fistulae.

All patients referred for evaluation of their AV dialysis access were considered for entry. Those with thrombosis, prior stent placement within the access circuit, and allergy to heparin were excluded. Patients were not enrolled more than once. Demographic information and access specific data was collected. The patients were randomized to either standard (60 seconds) or prolonged (180 seconds) balloon inflation time. If a patient had more than one stenosis, each narrowing was treated by the same inflation time as the initial lesion. Balloon sizing, inflation pressure, balloon type and heparin administration were controlled variables. Technical success of the angioplasty was defined as less than 30% residual stenosis and was evaluated for each lesion.

A total of 48 patients were enrolled: 27 patients (40 stenoses) randomized to the standard inflation group and 21 patients (36 stenoses) to the prolonged group. There were no significant differences in the demographic characteristics of the two inflation groups. Technical success rates in the standard and prolonged inflation groups were 75% and 88.9% respectively. Logistical regression analysis, when controlled for patient age, gender, and age of the AV access, demonstrated that technical failure was 4.7 times more likely in the standard versus the prolonged inflation group (95% CI: 1.1 – 20.1).

The prolonged (180 second) balloon inflation time significantly improved the likelihood of technical success for PTA of dialysis access stenoses. Using this technique has the potential to increase technical success without added cost.

Prolonged balloon inflation times can increase the technical success of dialysis access angiolasty using standard PTA balloon catheters.

Forauer, A, Hoffer, E, Standard versus Prolonged Angioplasty Balloon Inflation in the Treatment of Hemodilaysis-related Venous Stenoses.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5007630.html