Angiographic mapping of AV fistula related vascular complications in ESRD via multislice CT; adjuvant role in correlation with CDUS

Abstract

Background: To evaluate the role and usefulness of Multislice CT angiography (CTA) and color Doppler US (CDUS) in assessment of vascular tree of AVFs and comprehensive evaluation of possible shunt complications in ESRD patients on hemodialysis.Methods: Prospective analysis of vascular access related data was obtained from 30 patients (10 Male, 20 Female and age range 18-80 years) referred from hemodialysis unit via CTA and CDUS examination of the upper limbs. All patients were examined to identify the different types of fistula shunt related complications utilizing Doppler indices (PSV, EDV and RI) and different CTA 2D image reconstruction and 3D volume rendering techniques followed by surgical procedures as a gold standard within 2-7 days. Results: The study showed 15 patients with shunt related complications; aneurysm 33.3% (10 patients) followed by venous thrombosis 23.3% (7 patients), and arterial steal syndrome 13.3% (4 patients), and finally venous hypertension 6.6% (2 patients). Considering surgery as a gold standard the sensitivity and specificity of CDUS and CTA, in detecting aneurysms and stenosis was 100% and 100% respectively. The detection of subclavian occlusion sensitivity and specificity by CDUS was 70% and 85% respectively on the other hand CTA sensitivity and specificity was 100% and 100% respectively. Conclusions: The adjuvant diagnostic value of CTA with CDUS maximizes the evaluation of AV fistula related vascular complications approaching that of surgery.

The clinical importance of color Doppler ultrasonography in puncture related complications of hemodialysis vascular access

“…Among 4 patients diagnosed with stenosis, one cases had post-fistula stenosis, three cases had stenosis at the anastomotic site. This was in accordance with the finding of Tirinescu et al [19], who performed a large observational study on 97 patients, and reported juxtaanastomotic localization of stenosis in most cases, in the forearm, and in the upper arm AVF equally. Clinically pseudoaneurysms are diagnosed by the presence of a pulsatile mass with systolic murmur.…”

“…Stenosis of HD vascular access is common and may lead to thrombosis and the loss of the access. Thus, detection of stenosis in AVF before thrombosis could offer a strategy to improve AVF survival by early intervention [19]. Stenosis in AVF develops more frequently in juxtaanastomotic location, up to 4 cm from the anastomosis [20].…”

Value of duplex Doppler ultrasonography for the evaluation of dysfunctional hemodialysis access arteriovenous fistulas prior to endovascular interventions

“…Chandra et al found a j value of 0.77, whereas ours was 0.96 4. Other studies reported even lower success rates of central venous lesion detection by DUS 10,22. In our study, DUS detected correctly 95% of the central venous lesions.…”

Role of Color Doppler Ultrasonography in Assessment of Complications of Hemodialysis a-v Fistula

“…Stenosis of HD AVF is common and may lead to thrombosis and the loss of the access. Thus, detection of stenosis in AVF before thrombosis could offer a strategy to improve AVF survival by early intervention (Soliman et al, 2015).…”