Yoshiaki Watanabe MD, PhD, Presenter: Nothing to Disclose

Katsuhiko Matsuura MD, Abstract Co-Author: Nothing to Disclose

Ayumu Ookawa BA, Abstract Co-Author: Nothing to Disclose

Naoyuki Matsunaga, Abstract Co-Author: Employee, Yufu Itonaga Corporation

Osamu Tanaka MD, Abstract Co-Author: Nothing to Disclose

To evaluate the frequency of the valve-related stenosis of the native fistula and the efficacy of PTA in these lesions.

From August 2005 to February 2008, 30 percutaneous transluminal angioplasties (PTA) of hemodialysis related native fisutula venous stenoses were evaluated in 30 patients. The native fistulas treated were Tabatiere in nine, Brescia-Cimino in fifteen, upper arm in six. Forty-two stenotic lesions confirmed by contrast angiography were evaluated by Intravascular Ultrasound (IVUS) before and post PTA. Existence of the cusp in the stenotic lesion was confirmed by the longitudinal view of IVUS. Vessel diameter was measured by angiography. The diameter and cross-sectional area (CSA) of the lumen and external elastic membrane (EEM) was measured by IVUS.

High resolution real-time ultrasound images were obtained in all patients without complication. The frequency of valve-related stenoses was 41.5% and constituted almost half of the venous stenotic lesions. Differentiation between valve-related stenosis and plaque-related stenosis was difficult by angiography. Location of the stenotic lesions were 3 in the hand, 28 in the forearm and 11 in the upper arm.  In the forearm, 20 lesions were plaque-related and 8 lesions were valve-related,  In the upperarm, 4 lesions were plaque-related and 7 lesions were valve-related. By  Fisher exact test, The frequency of valve-related stenoses was higher in the upper arm than in the forearm, and the frequency of plaque-related stenosis was higher in the forearm than in the upper arm (p=0.0494). Constricted to the conventional balloon PTA treated group, post PTA luminal dilatation increase had no difference between plaque-related group and valve-related group by both angiography and IVUS (307.7% vs 317.2% by angiography, 217.9% vs 216.1% by IVUS, p<0.001).

The frequency of valve-related stenoses was surprisingly high and the frequency of valve-related stenoses was higher in the upper arm than in the forearm and this might be related to flow volume. There was no difference between subintimal plaque related stenoses group and valve related stenoses group in the dilatation rate post PTA by standard balloon.

Valve-related stenosis plays an important role in venous portion of native fistula and the frequency is high. The efficacy of PTA has no difference compared with plaque-related stenosis.

Watanabe, Y, Matsuura, K, Ookawa, A, Matsunaga, N, Tanaka, O, Valve-related Stenosis of Native Fistula by Intravascular Ultrasound Examination: Incidence and Efficacy of Percutaneous Transluminal Angioplasty.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6005338.html