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Kidney Week

Abstract: FR-PO722

Adjunctive Use of Color-Coded Digital Subtraction Angiography During Percutaneous Transluminal Intervention of Hemodialysis Vascular Access

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Teh, Swee Ping, Singapore General Hospital, Singapore, Singapore
  • Tan, Ru Yu, Singapore General Hospital, Singapore, Singapore
  • Pang, Suh Chien, Singapore General Hospital, Singapore, Singapore
  • Lee, Kian Guan, Singapore General Hospital, Singapore, Singapore
  • Ong, Alicia Huiying, Singapore General Hospital, Singapore, Singapore
  • Chong, Tze tec, Singapore General Hospital, Singapore, Singapore
  • Gogna, Apoorva, Singapore General Hospital, Singapore, Singapore
  • Tan, Chieh-suai, Singapore General Hospital, Singapore, Singapore
Background

Parametric color-coding of digital subtraction angiography (DSA) has been successfully used in interventional neuroimaging and diagnostic imaging for peripheral arterial disease. We aimed to examine the utility of color-coded DSA for quantitative hemodynamic analysis in percutaneous transluminal angioplasty (PTA) of hemodialysis access.

Methods

This is a prospective, single center study. DSA acquisitions were post-processed into color-coded images. Regions of interest (ROI) were selected for each image. Hemodynamic parameters including time-to-peak (TTP) contrast opacification, contrast transit time (TT) and contrast decay time were obtained. These parameters were compared pre-and post-PTA.

Results

DSA of 16 patients who underwent PTA were included. 9 interventions were performed on arteriovenous fistulas and 7 on arteriovenous grafts with median access age of 3.5 ± 3.1 years (interquartile range 1.8-6.7). All patients had improvement in percentage of stenosis post PTA with a mean difference of 39.71 ± 16.25% (p<0.01). TTP improved significantly following PTA, with mean reduction of 0.35 ± 0.65 seconds (s) (p<0.01) and 0.60 ± 0.83s (p<0.01) for pre- and post- stenosis ROIs respectively. Mean reduction in contrast transit was 0.23 ± 0.53s (p=0.04). Receiver operator characteristics analysis showed that 10% contrast decay time at 0.05s correlated with access flow of 800cc/min with sensitivity of 0.91 and specificity of 0.5 (area under the curve 0.89, 95% confidence interval 0.71 – 1.0).

Conclusion

Adjunctive usage of parametric color-coded DSA could provide hemodynamic information, which may be useful for decision-making during PTA of hemodialysis access.