Angiography of Hemodialysis Fistulas and Grafts

Beathard, Gerald A.

doi:10.1111/sdi.12595

Cited by 3 publications

(2 citation statements)

References 64 publications

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“…DSA was the gold standard for stenosis detection, 16 and it was performed before dialysis using the “arterial” needle for contrast medium injection. Accesses were visualized in their entirety from the feeding artery (inverting the flow by manually compressing the outflow vein, or using an inflated sphygmomanometer to visualize the upstream circuit) to the right atrium, to detect and locate any StA using an electronic caliper.…”

Section: Methodsmentioning

confidence: 99%

Screening for hemodialysis graft stenosis and short-term thrombosis risk: A comparison of the available tools

et al. 2019

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Introduction: Guidelines recommend hemodialysis graft screening to identify and repair significant (>50%) stenosis at high risk of thrombosis, but there is insufficient evidence to prefer one or other screening tool due to the lack of studies comparing all available options. Methods: Seeking an optimal screening approach, we compared the performance of all currently used tools (duplex ultrasound to detect significant stenosis (StD) and measure access blood flow (QaD), ultrasound dilution access blood flow (QaU), static venous intra-access pressure ratio (VAPR), dynamic arterial and venous pressures measurement, and monitoring) for diagnosing significant angiography-proven stenosis (StA) and predicting incipient thrombosis (occurring within 4 months) in 62 grafts. All thrombotic and symptomatic acute hypotension episodes were recorded during follow-up. Results: VAPR > 0.70 and QaU < 1600 mL/min were the best indicators to angiography for those aiming to identify the majority of StA (91% sensitivity) and QaU < 1000 mL/min or StD for those aiming to avoid unnecessary angiograms (95%–93% positive predictive value). At Cox’s analysis, the only significant thrombosis predictors were acute hypotension episodes (relative risk = 4.4 (95% confidence interval = 2.2–8.8), p < 0.0001) and QaU or QaD (14% (95% confidence interval = 8–21) or 16% (95% confidence interval = 6–25) increased risk per 100 mL/min drop in Qa, p < 0.003). Thrombosis risk (adjusted for acute hypotension) became significantly higher at QaU = 1000–700 mL/min (relative risk = 3.6 (95% confidence interval = 1.6–8.2), p < 0.001) and QaD = 1300–1000 mL/min (relative risk = 3.1 (95% confidence interval = 1.1–12.8), p = 0.031). The proportion of thromboses attributable to acute hypotension was 40% (95% confidence interval = 24–57). Conclusions: Our comparative study showed that an effective screening for graft stenosis and short-term thrombosis risk can rely on Qa surveillance alone, and suggested that avoiding acute hypotension and correcting stenosis at QaU < 1000 mL/min or QaD < 1300 mL/min can contain thrombosis risk.

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Section: Methodsmentioning

confidence: 99%

Screening for hemodialysis graft stenosis and short-term thrombosis risk: A comparison of the available tools

et al. 2019

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“…An intimate understanding of fistula hemodynamics is required by the interventionalist in order to decrease the risk of CO 2 embolism to the brain in the case of arterial reflux of the contrast agent into the aorta. Given the invasive nature of DSA, its use should be limited in patients with suspected deep or superficial AVF/AVG infection due to the theoretical increased risk of septicemia ( 34 ).…”

Section: Imaging Evaluation Of Avfs and Avgsmentioning

confidence: 99%

Multimodality imaging evaluation of arteriovenous fistulas and grafts: a clinical practice review

Gonzalez¹,

Bookwalter²,

Foley³

et al. 2023

Cardiovasc Diagn Ther

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Arteriovenous fistulas (AVFs) and grafts (AVGs) are the preferred forms of vascular access for hemodialysis in patients with severe renal dysfunction. Multimodality imaging plays an important role in the pre-procedural evaluation of these patients. Ultrasound is often used for pre-procedural vascular mapping in preparation for the creation of an AVF or AVG. Pre-procedural mapping includes a comprehensive evaluation of the arterial and venous vasculature including evaluation of vessel diameter, stenosis, course, presence of collateral veins, wall thickness and wall abnormalities. Computed tomography (CT), magnetic resonance imaging (MRI) or catheter angiography are used when sonography is not available or when further characterization of sonographic abnormalities is required. Following the procedure, routine surveillance imaging is not recommended. If there are any clinical concerns or if physical examination is inconclusive, further evaluation with ultrasound is warranted. Ultrasound allows for assessment of vascular access site maturation by evaluating the time-averaged blood flow and helping characterize the outflow vein in the case of an AVF. CT and MRI can play a complementary role to ultrasound. Vascular access site complications include non-maturation, aneurysm, pseudoaneurysm, thrombosis, stenosis, steal phenomena or occlusion typically of the outflow vein, infection, bleeding and rarely angiosarcoma. In this article, we review the role of multimodality imaging in the pre- and post-procedural evaluation of patients with AVF and AVG. Additionally, novel technologies of vascular access site creation using endovascular techniques and upcoming non-invasive imaging techniques for evaluation of AVFs and AVGs are discussed.

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A portable easy-to-use triboelectric sensor for arteriovenous fistula monitoring in dialysis patients

Pullano,

Oliva,

Presta

et al. 2025

Sensors International

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Angiography of Hemodialysis Fistulas and Grafts

Cited by 3 publications

References 64 publications

Screening for hemodialysis graft stenosis and short-term thrombosis risk: A comparison of the available tools

Screening for hemodialysis graft stenosis and short-term thrombosis risk: A comparison of the available tools

Multimodality imaging evaluation of arteriovenous fistulas and grafts: a clinical practice review

A portable easy-to-use triboelectric sensor for arteriovenous fistula monitoring in dialysis patients

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