Hemodialysis access stenosis: early detection with color Doppler US.

Older, R A; Gizienski, Terri-Ann; Wilkowski, Michael J.; Angle, John F.; Côté, Diplomate Acvim Etienne

doi:10.1148/radiology.207.1.9530312

Cited by 42 publications

(19 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As a cost-effective method, it allows evaluation of vascular access maturity and diagnosis of complications in experienced hands [24 -27]. As a result of sonographic stenosis detection, flow measurement and the diagnosis of thrombotic occlusions, the cause of a vascular access insufficiency can usually be reliably identified on ultrasound [28,29]. In addition to stenosis detection, sonographic followup after treatment is readily possible ( • " Fig.…”

Section: Ultrasoundmentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

View full text Add to dashboard Cite

A wide variety of diagnostic and minimally invasive modalities is currently available to radiologists for providing sufficient medical care for dialysis patients. In addition to clinical examination, ultrasound is the first line imaging method in suspected dialysis vascular access dysfunction. The percutaneous approach is the primarily recommended therapeutic option in many cases. This article reviews the current diagnostic and therapeutic methods in dialysis vascular access insufficiency. Key Points: ??Vascular access dysfunction is often elicited by stenosed vessels, which are regularly associated with concomitant thrombosis. ??Stenoses are commonly observed in the anastomosis, vascular access vein and also in the central venous system. ??Beside the clinical examination, sonography is the diagnostic method of first choice. ??Percutaneous balloon dilatation frequently is the first treatment option. Citation Format: ??Kamper L, Faizy TD, Haage P. Diagnosis and Treatment of Insufficient Dialysis Vascular Access. Fortschr R?ntgenstr 2015; 187: 360???371

show abstract

Section: Ultrasoundmentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

View full text Add to dashboard Cite

show abstract

“…[4] Color flow Doppler ultrasound (US) is widely used for surveillance and detection of vascular access dysfunction with a good sensitivity. [5] Moreover, this technique has good correlation in diagnosing anatomic stenosis with fistulography. [6] Duplex US has been used as a guide for managing failing vascular access during PTA; [7] however, the role of duplex US in the management of thrombosed native arteriovenous fistula (AVF) is unknown.…”

Section: Introductionmentioning

confidence: 98%

Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

et al. 2005

View full text Add to dashboard Cite

Background. To investigate the safety, feasibility, efficacy, and long-term patency rate of manual declotting under duplex ultrasound (US) guidance followed by percutaneous transluminal angioplasty (PTA) in thrombosed native arteriovenous fistulas (AVFs). Methods. Of 87 consecutive thrombosed AVFs evaluated by duplex US, 22 patients with 25 recently thrombotic events in 22 AVFs were suitable for manual declotting. PTA was performed following successful declotting, and long-term patency was assessed. Results. The procedure success rate of manual declotting was 80% (20 of 25), and a residual stenosis of 74 ± 9% was identified by duplex US after declotting. PTA reduced the diameter stenosis to 25 ± 6% and increased the lumen diameter from 1.33 ± 0.85 mm to 4.62 ± 0.98 mm. Neither embolic nor bleeding complications were noted during the procedure. The average procedure time and the fluoroscopy time were 28.4 ± 9.9 and 7.2 ± 4.1 minutes, respectively. Primary patency rates at 1, 2, and 3 years were 47%, 35%, and 28%; assisted primary patency rates at 1, 2, and 3 years were 71%, 63%, and 63%; and secondary patency rates at 1, 2, and 3 years were 76%, 71%, and 63%, respectively, during a maximum follow-up period of 42 months. Conclusion. The combination of duplex US-guided manual declotting and angioplasty of underlying stenosis is a safe and feasible method to treat recently thrombosed native AVFs in selected patients. It simplifies the interventional procedure, reduces cost and radiation exposure time, and extends life span of dialysis fistula with acceptable long-term patency rate.

show abstract

“…Neben einer Einengung der Shuntvene birgt insbesondere ein verminderter Einstrom infolge einer Einengung der Anastomose die Gefahr eines Shuntverschlusses mit der Notwendigkeit einer operativen Korrektur [1,7]. Infolge unzureichender Antikoagulation und bei zunehmender neointimaler Proliferation besteht die Gefahr einer appositionellen Thrombusbildung [1,5,11,21]. Als weitere hämodynamisch relevante Komplikationen können sich Pseudoaneurysmen mit intraluminalen Thromben der Shuntvene und Intimadissekate der zuführenden Arterie oder der Anastomose infolge von Punktionen oder einer endoluminalen Intervention ausbilden [10,11].…”

Section: Materials Und Methodeunclassified

“…Während sich Komplikationen wie die Ausbildung einer Stenose der Shuntvene, eine Shuntvenenthrombose oder ein venöses Aneurysma sicher mit der FKDS diagnostizieren lassen, gestaltet sich die quantitative Beurteilung einer Anastomosenstenose schwieriger [1,5,15]. Hierzu sind hämodynamische Parameter, wie beispielsweise die maximale systolische Spitzengeschwindigkeit, nur bedingt geeignet [1,4,5,11]. In den meisten Fällen gelingt die direkte Flussbeurteilung nicht, da es durch Vibrationsartefakte zu einer deutlichen Gefäßüberzeichnung kommt [11,16].…”

Section: Introductionunclassified

“…Diesbezüg-lich erweist sich die Bestimmung der maximalen Flussgeschwindigkeiten, des arteriellen oder venösen Volumenflusses als unzuverlässig, da eine deutliche Winkelabhängigkeit der Messungen besteht und sich durch Kompression die Gefäßkaliber deutlich ändern können. Zwar deutet eine maximale systolische Flussgeschwindigkeit von > 400 cm/s in den meisten Fällen auf eine hochgradige Stenose hin [1,5,11], dennoch finden sich in Fällen mit hohem Volumenfluss vergleichbare Werte auch ohne eine relevante Anastomosenstenose [2,4,7,11].…”

Section: Introductionunclassified

See 1 more Smart Citation

B-Flow zur verbesserten sonographischen Beurteilung von Dialyse-Shunt-Stenosen

Jung¹,

Kubale²,

Clevert³

et al. 2004

Fortschr Röntgenstr

View full text Add to dashboard Cite

ZusammenfassungZiel: Es sollte überprüft werden, inwieweit die noch neue Technik des B-Flow eine verbesserte sonographische Flusserfassung bei stenosierten Hämodialyseshunts ermöglicht. Material und Methode: Bei 50 Patienten (im Mittel 58 Jahre) mit Brescia-Cimino-Shunts (27 radiale, 23 cubitale A-V-Fisteln) wurden prospektiv Untersuchungen mit der i. a. DSA und dem Gefäßultra-schall durchgeführt. Voraussetzung für die Untersuchungen waren ein Flussvolumen < 400 ml/min, eine vermutete hämodyna-misch relevante Stenose im Bereich der Anastomose oder der Shuntvenen. Die Ultraschalluntersuchungen erfolgten mit einem Multifrequenzschallkopf Purpose: To evaluate the new technique of B-flow ultrasound in assessing stenoses of hemodialysis fistulas. Materials and Methods: 50 patients (mean age 58 years) with Brescia-CiminoShunts (27 shunts of the radial and 23 of the cubital artery) were prospectively assessed with intraarterial DSA and vascular ultrasound by independent examiners. Eligibility for the study was a shunt-volume of less than 400 ml/min and an angiographically suspected hemodynamically significant stenosis of the anastomosis or of shunt veins. Sonography was performed with a multifrequency ultrasound probe (5 to 10 MHz, Logic 700, GE) using B-mode, color coded Doppler sonography (CCDS) and B-flow technique. Results: Anastomotic stenosis and stenosis of the shunt veins were equally distributed, found in 25 patients each. The measurements of the residual lumen of the 25 anastomotic stenoses were 1.47 to 3.43 mm (average: 2.3 mm) for intraarterial DSA, 1.57 to 3.73 mm (average: 2.6 mm) for B-mode ultrasound, 1.97 to 4.17 mm (average: 2.9 mm) for CCDS, 1.43 to 3.47 mm (average: 2.3 mm) for B-flow technique in the brightness mode and 1.6 to 3.47 mm (average: 2.4 mm) for B-flow technique in the B-mode. The brightness mode of the B-flow correlated best with intraarterial DSA (r=0.994), with a significantly lower correlation between CCDS and intraarterial DSA. B-flow displays less vascular distortion within the stenosis and fewer flow artifacts. Even in angulated stenoses, the detected intra-and poststenotic flow was markedly less angle-dependent in comparison with CCDS. B-flow clearly facilitates the visualization of hypoechoic plaques and intima proliferation. Furthermore, excentric cicatricial stenoses, intima flaps or hypoechoic thrombi, which were not seen with DSA or B-mode, showed improved visualization in

show abstract

Hemodialysis access stenosis: early detection with color Doppler US.

Abstract: Color Doppler US is more sensitive than clinical or laboratory methods for detection of hemodialysis access stenosis. Screening with US appears to enable earlier detection and therapy.

Cited by 42 publications

References 0 publications

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

B-Flow zur verbesserten sonographischen Beurteilung von Dialyse-Shunt-Stenosen

Contact Info

Product

Resources

About