An experience of using pressure wire^TM in the treatment of PTA in cases of venous hypertension

Abstract

A 62-year-old male patient began to receive hemodialysis due to end-stage renal disease in the presence of chronic glomerulonephritis and arteriovenous fistula (AVF) and an arteriovenous graft (AVG) was frequently established by the obstruction of these. The last AVG was established in the left upperarm in 2008 and swelling of the left upper limb appeared around February 2010. Therefore, we performed percutaneous transluminal angioplasty (PTA) with balloon angioplasty and stent placement for the stenotic brachiocephalic vein. Left upper extremity swelling did not improve; however, we believe that there is a potential for another lesion in addition to lesions in the left brachiocephalic vein stenosis as a cause of venous hypertension. We again performed PTA with angiography using the pressure wire^TM. Angiography demonstrated 90% stenosis of the length of the distal approximately 20mm prior to stenting in the left brachiocephalic vein. The pressure wire^TM also demonstrated 8mmHg at the superior vena cava (SVC), an increase in pressure and 53mmHg on the distal side of the brachiocephalic vein stenosis. Therefore, PTA with balloon angioplasty and stent placement was performed and angiography was obtained with a good extension. In addition, regarding the observations with pressure wire^TM, the pressure of SVC did not change and the pressure of the distal side of the brachiocephalic vein stenosis was reduced from 53 to 11mmHg before the PTA. In addition, angiography demonstrated that the stenotic lesion is unclear near the anastomosis at the graft and basilic vein, and the blood is flowing into the basilic vein retrogradely from the graft, with the proliferation of vessel collaterals. Concerning observations with the pressure wire^TM, the pressure near the anastomosis of the graft and basilic veins was high, at 86mmHg. The pressure wire^TM also suggesis lesions in the vicinity of the anastomosis graft and basilic vein responsible for venous hypertension, and it has been assumed that there are two lesions; therefore, we performed PTA with balloon angioplasty stenting at the same site. Angiography demonstrated the disappearance of reflux into the basilic and collateral veins. Using pressure wire^TM, the pressure of stenosis of the anastomosis graft and basilic vein was reduced from 86 to 12mmHg after the PTA. Thereafter, swelling of the upper arm during the next few days had almost disappeared after PTA. The pressure wire^TM was thought to be a diagnostic device that could aid in the enforcement of a difficult PTA.