Failing Hemodialysis Arteriovenous Fistula and Percutaneous Treatment: Imaging with CT, MRI and Digital Subtraction Angiography

Cavagna, E; D’Andrea, Paolo; Schiavon, Francesco; Tarroni, G

doi:10.1007/s002700010066

Cited by 44 publications

(28 citation statements)

References 9 publications

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“…Gadolinium-based contrast material-enhanced MR angiography methods are generally contraindicated in this patient population (2), given the association between gadolinium use and nephrogenic systemic fibrosis in end-stage renal disease patients (3-5) Although gadolinium can be administered in emergent situations where the benefit outweighs the risk, particularly when dialysis can be performed immediately following gadolinium use, it is still unsuited for more routine monitoring needs. The feasibility and diagnostic value of nonenhanced time-of-flight (TOF) MR angiography has been demonstrated for AVFs (6)(7)(8). However, TOF imaging is dependent on blood flow conditions, and flow complexities in tortuous AVF geometries can result in poor image quality and inaccurate assessment of the vascular geometry.…”

Section: Mr Imagingmentioning

confidence: 99%

USPIO-enhanced MR Angiography of Arteriovenous Fistulas in Patients with Renal Failure

Sigovan¹,

Gasper²,

Alley³

et al. 2012

Radiology

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Purpose:To determine the feasibility of using ferumoxytol-enhanced magnetic resonance (MR) angiography to depict the vasculature of hemodialysis fistulas and improve image quality compared with nonenhanced time-of-flight (TOF) MR angiography. Materials and Methods:The study was institutional review board approved and was in compliance with HIPAA regulations. All participants provided written informed consent. TOF and firstpass ferumoxytol-enhanced MR angiography were performed in 10 patients with upper extremity autogenous fistulas. Ferumoxytol was administered as a bolus solution containing 430 µmol of elemental iron. A qualitative comparison was performed on maximum intensity projection images. Lumen depiction was evaluated by using a fivepoint scale. The uniformity of intraluminal signal intensity was measured as the ratio between the mean signal intensity of the entirety of the imaged fistula and its standard deviation. The contrast-to-noise ratio (CNR) between intraluminal signal and adjacent tissue was evaluated as a function of image acquisition time. Lumen depiction scores, luminal signal heterogeneity, and CNR efficiency were compared between TOF and ferumoxytol-enhanced MR angiography by using a Wilcoxon-Mann-Whitney test. Results:Flow artifacts were greatly reduced by the use of ferumoxytol-enhanced MR angiography. Ferumoxytol-enhanced MR angiography had significantly better performance than TOF MR angiography as measured with the following: lumen depiction scores in all segments (mean, 4.7 6 0.1 [standard error of the mean]; vs 3.0 6 0.3 for arterial inflow, 4.1 6 0.3 vs 1.9 6 0.3 for arterial outflow, 3.7 6 0.3 vs 1.8 6 0.2 for anastomosis, and 4.5 6 0.2 vs 2.1 6 0.2 for venous outflow; P , .001), intraluminal signal homogeneity (0.3 6 0.02 vs 0.4 6 0.06, P = .005), and CNR efficiency in the venous outflow (5.1 6 0.6 vs 2.5 6 0.4, P = .01). Conclusion:This study demonstrates the feasibility of using ferumoxytol-enhanced MR angiography in imaging hemodialysis fistulas with consistently superior image quality compared with nonenhanced TOF MR angiography.q RSNA, 2012

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Section: Mr Imagingmentioning

confidence: 99%

USPIO-enhanced MR Angiography of Arteriovenous Fistulas in Patients with Renal Failure

Sigovan¹,

Gasper²,

Alley³

et al. 2012

Radiology

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“…Contrast-enhanced MRA, which does not involve radiation, has been used for evaluating dysfunctional AVFs, with impressive results. 16,19 Unfortunately, concerns about a possible relationship between gadolinium-based contrast agents and nephrogenic systemic fibrosis (NSF) have brought into question the use of these agents for MRA. 20,21 Although this relationship has not been conclusively proven, an association has been seen in several studies.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, gadolinium-based contrast materialenhanced MRA may be nephrotoxic in patients who have impaired renal function. 12e14 Non-enhanced time-of-flight (TOF)-MRA has been used for imaging AVFs, 15,16 but disturbed flow near the stenosis may result in an inaccurate assessment of the fistula geometry. Black-blood (BB)-MRA can clearly display the vascular geometry with the use of flow suppression techniques.…”

Section: Introductionmentioning

confidence: 99%

Non-contrast-enhanced MR angiography for detecting arteriovenous fistula dysfunction in haemodialysis patients

et al. 2015

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“…In a previous report, Lin et al [10] used single-slice CT angiography (SSCTA) to evaluate the vascular access in 9 hemodialysis patients and made comparison with results obtained with DSA and found that CT angiography correlated closely with DSA and spared some of the shortcomings of DSA. In another clinical study, Cavagna et al [11] compared the results of SSCTA, magnetic resonance angiography, and DSA in 13 patients in their evaluation of failing hemodialysis AVF and drew the conclusion that CT and magnetic resonance angiography can provide information regarding the degree of vascular impairment. However, the quality of images using SSCTA was much poorer, and the examination time was longer as compared with MSCTA.…”

Section: Discussionmentioning

confidence: 99%

Multislice Computed Tomographic Angiography in Evaluating Dysfunction of the Vascular Access in Hemodialysis Patients

Zhiguo

Shu

et al. 2006

Nephron Clin Pract

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Aims: To introduce our preliminary experience in using multislice computed tomographic (CT) angiography (MSCTA) to assess stenoses of the hemodialysis vascular access and to guide revising operation or percutaneous transluminal angioplasty (PTA). Methods: Contrast-enhanced 16-slice spiral CT was used to examine 22 hemodialysis patients with various dysfunctions of their vascular access. The transverse source images were reformatted as maximum intensity projection, volume-rendering, and multiple/curved planar reconstruction images. Results: The whole spectrum of arteriovenous fistulas (AVF) with the feeding artery, anastomoses, and outflow tract up to the superior caval vein was clearly displayed in all patients. According to the results of MSCTA, AVF-revising surgery was done in 11 patients, and PTA under the guide of digital subtraction angiography (DSA) was done in 5 patients. The results of MSCTA coincide with the findings of surgery or DSA in these 16 patients. Conclusions: In our opinion, MSCTA is a good noninvasive diagnostic technique to detect various hemodialysis vascular access abnormalities. It is more economical than DSA in the present medical settings and could replace DSA in the imaging of hemodialysis vascular access and provide important information for further AVF-revising surgery or PTA.

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Failing Hemodialysis Arteriovenous Fistula and Percutaneous Treatment: Imaging with CT, MRI and Digital Subtraction Angiography

Cited by 44 publications

References 9 publications

USPIO-enhanced MR Angiography of Arteriovenous Fistulas in Patients with Renal Failure

USPIO-enhanced MR Angiography of Arteriovenous Fistulas in Patients with Renal Failure

Non-contrast-enhanced MR angiography for detecting arteriovenous fistula dysfunction in haemodialysis patients

Multislice Computed Tomographic Angiography in Evaluating Dysfunction of the Vascular Access in Hemodialysis Patients

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