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Optical Coherence Tomography of Dialysis Graft after Angioplasty
IMAGES IN IR
Optical Coherence Tomography of Dialysis Graft after Angioplasty Roman Shingarev, MD, and Michael Allon, MD
Figure 1.
Figure 3.
Figure 2.
Figure 4.
Neointimal hyperplasia, the major cause of arteriovenous graft (AVG) stenosis, is not directly visualized by angiography. A 60-year-old woman on hemodialysis presented with a clotted AVG 30 days after its creation. Following percutaneous thrombectomy, angiography revealed severe (4 50%) stenosis at the graft (G)-vein (V) anastomosis (arrow in Fig 1). Optical coherence tomography performed using an intravascular Dragonfly catheter (St. Jude Medical, Westford, Massachusetts) delineated the intima in bright yellow. It demonstrated severe, focal, circumferential neointimal hyperplasia at the
stenotic site, encroaching into the venous lumen (asterisk in Fig 2). After high-pressure (20 atm) balloon angioplasty, angiography showed improvement in the stenosis at the graft (G)-vein (V) anastomosis (arrow in Fig 3). Repeat optical coherence tomography after angioplasty showed considerably increased lumen area with multiple dissections of the neointimal layer (arrowheads in Fig 4). Static mean pressure in the AVG was 24 mm Hg, and patient’s mean arterial pressure was 86 mm Hg. The patient subsequently underwent successful hemodialysis using the AVG.
From the Department of Medicine, University of Alabama at Birmingham, ZRB 624, 1530 Third Avenue South, Birmingham, AL 35294-0007. Received January 22, 2015; final revision received February 5, 2015; accepted February 6, 2015. Address correspondence to R.S.; E-mail: [email protected]
& SIR, 2015
Neither of the authors has identified a conflict of interest.
J Vasc Interv Radiol 2015; 26:870 http://dx.doi.org/10.1016/j.jvir.2015.02.002
Optical Coherence Tomography of Dialysis Graft after Angioplasty Roman Shingarev, MD, and Michael Allon, MD
Figure 1.
Figure 3.
Figure 2.
Figure 4.
Neointimal hyperplasia, the major cause of arteriovenous graft (AVG) stenosis, is not directly visualized by angiography. A 60-year-old woman on hemodialysis presented with a clotted AVG 30 days after its creation. Following percutaneous thrombectomy, angiography revealed severe (4 50%) stenosis at the graft (G)-vein (V) anastomosis (arrow in Fig 1). Optical coherence tomography performed using an intravascular Dragonfly catheter (St. Jude Medical, Westford, Massachusetts) delineated the intima in bright yellow. It demonstrated severe, focal, circumferential neointimal hyperplasia at the
stenotic site, encroaching into the venous lumen (asterisk in Fig 2). After high-pressure (20 atm) balloon angioplasty, angiography showed improvement in the stenosis at the graft (G)-vein (V) anastomosis (arrow in Fig 3). Repeat optical coherence tomography after angioplasty showed considerably increased lumen area with multiple dissections of the neointimal layer (arrowheads in Fig 4). Static mean pressure in the AVG was 24 mm Hg, and patient’s mean arterial pressure was 86 mm Hg. The patient subsequently underwent successful hemodialysis using the AVG.
From the Department of Medicine, University of Alabama at Birmingham, ZRB 624, 1530 Third Avenue South, Birmingham, AL 35294-0007. Received January 22, 2015; final revision received February 5, 2015; accepted February 6, 2015. Address correspondence to R.S.; E-mail: [email protected]
& SIR, 2015
Neither of the authors has identified a conflict of interest.
J Vasc Interv Radiol 2015; 26:870 http://dx.doi.org/10.1016/j.jvir.2015.02.002