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CardioVascular and Interventional Radiology

, Volume 28, Issue 1, pp 17–22 | Cite as

Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

  • Richard J. Harp
  • S. William Stavropoulos
  • Alan G. Wasserstein
  • Timothy W.I. ClarkEmail author
CLINICAL INVESTIGATIONS

Abstract

Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.

Methods: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n = 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.

Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14).

Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension. Patients with ESRD are more likely to have pulmonary hypertension.

Keywords

Dialysis Hypertension, pulmonary Thrombectomy 

References

  1. 1.
    United States Renal Data System (2002) USRDS annual data report. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney DiseasesGoogle Scholar
  2. 2.
    Smits, HF, Smits, JH, Wust, AF, Buskens, E, Blankestijn, PJ 2002Percutaneous thrombolysis of thrombosed haemodialysis access grafts: Comparison of three mechanical devicesNephrol Dial Transplant17467473Google Scholar
  3. 3.
    Falk, A, Mitty, H, Guller, J, Teodorescu, V, Uribarri, J, Vassalotti, J 2001Thrombolysis of clotted hemodialysis grafts with tissue type plasminogen activatorJ Vasc Interv Radiol12305311PubMedGoogle Scholar
  4. 4.
    Trerotola, SO, Johnson, MS, Schauwecker, DS, Davidson, DD, Filo, RS, Zhou, XH,  et al. 1996Pulmonary emboli from pulse-spray and mechanical thrombolysis: Evaluation with an animal dialysis-graft modelRadiology200169176PubMedGoogle Scholar
  5. 5.
    Smits, HF, Rijk, PP, Isselt, JW, Mali, WP, Koomans, HA, Blankestijn, PJ 1997Pulmonary embolism after thrombolysis of hemodialysis graftsJ Am Soc Nephrol814581461PubMedGoogle Scholar
  6. 6.
    Swan, TL, Smyth, SH, Ruffenach, SJ, Berman, SS, Pond, GD 1995Pulmonary embolism following hemodialysis access thrombolysis/thrombectomyJ Vasc Interv Radiol6683686PubMedGoogle Scholar
  7. 7.
    Petronis, JD, Regan, F, Briefel, G, Simpson, PM, Hess, JM, Contoreggi, CS 1999Ventilation-perfusion scintigraphic evaluation of pulmonary clot burden after percutaneous thrombolysis of clotted hemodialysis access graftsAm J Kidney Dis34207211PubMedGoogle Scholar
  8. 8.
    Fedullo, PF, Auger, WR, Kerr, KM, Rubin, LJ 2001Chronic thromboembolic pulmonary hypertensionN Engl J Med34514651472CrossRefPubMedGoogle Scholar
  9. 9.
    Riberiro, A, Lindmarker, P, Johnsson, H, Juhlin-Dannfelt, A, Jorfeldt, L 1999Pulmonary embolism: One year follow-up with echocardiography Doppler and five-year survival analysisCirculation9913251330Google Scholar
  10. 10.
    Peterson, K 1999Acute pulmonary embolism: Has its evolution been redefined?Circulation9912801283Google Scholar
  11. 11.
    Tow, DE, Wagner, HN 1967Recovery of pulmonary arterial blood flow in patients with pulmonary embolismN Engl J Med27610531059PubMedGoogle Scholar
  12. 12.
    Anon1973The Urokinase Pulmonary Embolism TrialCirculation47II-1II-108Google Scholar
  13. 13.
    Dolmatch, BL, Gray, RJ, Horton, KM 1994Will iatrogenic pulmonary embolization be our pulmonary embarrassment?Radiology191615617discussion 18PubMedGoogle Scholar
  14. 14.
    Herzog, CA, Ma, JZ, Collins, AJ 1998Poor long-term survival after acute myocardial infarctions among patients on long-term dialysisN Engl J Med339799805CrossRefPubMedGoogle Scholar
  15. 15.
    Berger, M, Haimowitz, A, Tosh, A, Berdoff, R, Goldberg, E 1985Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasoundJ Am Coll Cardiol6359365PubMedGoogle Scholar
  16. 16.
    Kitabatake, D, Goldberg, SJ, Allen, HD, Loeber, C 1983Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler techniqueCirculation68302308Google Scholar
  17. 17.
    Schiller, NB 1990Pulmonary artery pressure estimation by Doppler and 2-D echocardiographyCardiol Clin8277287PubMedGoogle Scholar
  18. 18.
    Beathard, GA, Welch, BR, Maidment, HJ 1996Mechanical thrombolysis for the treatment of thrombosed hemodialysis access graftsRadiology200711716PubMedGoogle Scholar
  19. 19.
    Droste, DW, Kühne, K, Schaefer, RM, Ringelstein, EB 2002Detection of microemboli in the subclavian vein of patients undergoing haemodialysis and haemodiafiltration using pulsed Doppler ultrasoundNephrol Dial Transplant17462466Google Scholar
  20. 20.
    Tveit, DP, Hypolite, IO, Hshieh, P, Cruess, D, Agodoa, LY, Welch, PG, Abbott, KC 2002Chronic dialysis patients have high risk for pulmonary embolismAm J Kid Dis3910111017CrossRefPubMedGoogle Scholar
  21. 21.
    Kinney, TB, Valji, K, Rose, SC, Yeung, DD, Oglevie, SB, Roberts, AC, Ward, DM 2000Pulmonary embolism from pulse-spray pharmacomechanical thrombolysis of clotted hemodialysis grafts: Urokinase versus heparinized salineJ Vasc Interv Radiol1111431152PubMedGoogle Scholar
  22. 22.
    Moser, KM, Auger, WR, Fedullo, PF 1990Chronic major vessel thromboembolic pulmonary hypertensionCirculation8117351743PubMedGoogle Scholar
  23. 23.
    Wartski, M, Collignon, MA 2000Incomplete recovery of lung perfusion after 3 months in patients with acute pulmonary embolism treated with antithrombotic agentsJ Nucl Med4110431048Google Scholar
  24. 24.
    Azarian, R, Wartski, M, Collignon, MA, Parent, F, Hervé, P, Sors, H, Simonne, G 1997Lung perfusion scans and hemodynamics in acute and chronic pulmonary embolismJ Nucl Med38980983PubMedGoogle Scholar
  25. 25.
    Moser, KM, Bloor, CM 1993Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertensionChest103685692PubMedGoogle Scholar
  26. 26.
    Kim, H, Yung, GL, Marsh, JJ, Knonpka, RG, Pederson, CA, Chiles, PG, Morris, TA, Channick, RN 2000Pulmonary vascular remodeling distal to pulmonary artery ligation is accompanied by upregulation of endothelin receptors and nitric oxide synthaseExp Lung Res26287301CrossRefPubMedGoogle Scholar
  27. 27.
    Fisherman, AJ, Moser, KM, Fedullo, PF 1983Perfusion lung scans versus pulmonary angiography in evaluation of suspected primary pulmonary hypertensionChest84679683PubMedGoogle Scholar
  28. 28.
    Chait, A, Summers, D, Krasnow, N, Wechsler, BM 1967Observations on the fate of large pulmonary emboliAJR Am J Roentgenol100364367Google Scholar
  29. 29.
    Lottermoser, K, Petras, S, Poge, U, Fimmers, R, Hertfelder, HJ, Schiermeyer, B, Vetter, H, Dusing, R 2001The activity of t-PA is markedly decreased in chronic renal failureEur J Med Res28372376Google Scholar
  30. 30.
    Salvati, F, Liani, M 2001Role of platelet surface receptor abnormalities in the bleeding and thrombotic diathesis of uremic patients on hemodialysis and peritoneal dialysisInt J Artif Organs24131135PubMedGoogle Scholar
  31. 31.
    Berlyne, GM, Ari, JB, Pest, D, Weinberger, J 1971Pulmonary embolism: A complication of the Cimino-Brescia fistula. A report of three casesIsr J Med Sci7303305PubMedGoogle Scholar
  32. 32.
    Lazzaro, CR, Trerotola, SO, Shah, H, Namyslowski, J, Moresco, K, Patel, N 1999Modified use of the Arrow-Trerotola percutaneous thrombectomy device for the treatment of thrombosed hemodialysis access graftsJ Vasc Interv Radiol1010251031PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • Richard J. Harp
    • 1
  • S. William Stavropoulos
    • 1
  • Alan G. Wasserstein
    • 1
  • Timothy W.I. Clark
    • 1
    Email author
  1. 1.Section of Interventional Radiology, Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaUSA

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