Ultrahigh-pressure versus high-pressure angioplasty for treatment of venous anastomotic stenosis in hemodialysis grafts: is there a difference in patency?

PURPOSE: Ultrahigh-pressure (UHP) balloon catheters were compared with high-pressure (HP) balloon catheters to determine if there was a difference in patency after percutaneous transluminal angioplasty (PTA) of venous anastomotic stenoses. MATERIALS AND METHODS: A retrospective study was conducted from January 2001 to September 2005 that included 22 patients with synthetic hemodialysis grafts who underwent 110 PTA procedures for venous anastomotic stenoses. Data collected included graft configuration and location, percent stenosis, balloon type used, residual stenosis, and total access blood flow before and after intervention. Patency from time of initial PTA to the next intervention was estimated with the Kaplan-Meier technique, with initial failures included in the analysis. RESULTS: A total of 55 PTAs were performed in each group. Technical success rate was 96% (n = 106) and clinical success rate was 100%. Median survival times were 4.6 months for the UHP cohort and 5.4 months for the HP group. When each event was considered independent, the difference was significant (P = .014). However, when each PTA event was considered dependent on earlier PTA events, no significant difference in patency was observed (P = .64). The mean increases in access blood flow rate by ultrasound dilution (available for 71 events) after PTA were 264 mL/min with UHP and 524 mL/min with HP (P = .14, Student t test). One minor complication (0.9%) of focal extravasation after PTA occurred and resolved with prolonged balloon inflation. CONCLUSION: Routine use of UHP for PTA of venous anastomotic stenoses in synthetic hemodialysis grafts was not associated with any significant change in patency compared with routine HP balloon angioplasty.

Discordance of community and hospital ultrasound reports for urological abnormalities.

INTRODUCTION: In Ontario, community ultrasound clinics do not require the on-site presence of a radiologist at the time of imaging. In hospitals, a radiologist is always present for this step. We compared the discrepancy rate of community and hospital ultrasound reports in a urology practice. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients who had abdominal ultrasound performed in the community and in the hospital between April 1, 2001 and June 30, 2005. Reports were examined for indication, findings and whether there was a discrepancy. A medical student, a resident, and a staff physician each independently reviewed the findings. RESULTS: One hundred and twenty-two patients had abdominal ultrasound performed in the community and were followed up with hospital imaging. Sixty-nine patients had a community ultrasound followed by hospital ultrasound, with a discordance rate of 52.2%. Fifty-three patients had a community ultrasound and then a hospital CT scan, with a discordance rate of 43.3%. Of patients with discordant ultrasound reports, 23 had an additional CT scan in which all findings were consistent with the hospital ultrasound findings. DISCUSSION: We found a very high discordance rate between community and hospital ultrasound reports. This is consistent with a study showing that the active role of the radiologist in ultrasound imaging is very important for accurate reporting. CONCLUSION: Ultrasound reports form the community in patients referred to our urology practice have a high discrepancy rate when compared with ultrasound or CT scan reports from the hospital setting. We found no discordance between ultrasound and CT scan findings from imaging performed in hospital. We recommend standardization of abdominal ultrasound imaging protocols across Canada to include the presence of a radiologist at all times.