Hemodialysis grafts: color Doppler flow imaging correlated with digital subtraction angiography and functional status.

Abstract

Twenty-two patients with hemodialysis grafts were prospectively evaluated with color Doppler flow imaging and digital subtraction angiography (DSA). Eighteen patients had normal functional parameters during hemodialysis, and four had increased venous pressure during hemodialysis. Color Doppler flow imaging allowed identification of nine macroaneurysms related to wall degeneration, two cases of spontaneous fistula formation between the graft and peripheral veins, and 20 stenoses. Use of color Doppler flow imaging led to overestimation of the degree of stenosis at the venous anastomosis when compared with use of angiography. Three cases of subclavian venous stenosis were identified only at angiography. Color Doppler flow imaging appears accurate in the detection of stenoses and seems sufficient for follow-up of normally functioning grafts. However, because of its low sensitivity for identification of proximal stenoses and the necessity of obtaining an angiogram to plan surgical or percutaneous correction, DSA remains the technique of choice.

Successful Hemodialysis Using an Iatrogenic Graft-to-Vein Fistula in Failing Arteriovenous Graft with Chronic Thrombotic Occlusion

“…A graft-to-vein fistula can be asymptomatic and incidentally detected by physical examination, such as a palpable thrill, over the arterial limb or intervention for dysfunction (2,7,9). A graft-to-vein fistula can be benign with spontaneous closure.…”

Magnetic Resonance Angiography as a Technique for the Visualization of Hemodialysis Shunts

“…The techniques generally employed are arterial or ve nous DSA [9,10] or color Doppler flow imaging [11][12][13].…”

“…Furthermore, it is better able than DSA to image structures outside the shunt (e.g. hematoma or abscesses) [11,12], It is disadvantageous that, due to the size of the sector scan, this technique can only focus on a relatively small section of the dialysis shunt at the same time. Therefore orientation and documentation arc more difficult [11,12].…”

“…hematoma or abscesses) [11,12], It is disadvantageous that, due to the size of the sector scan, this technique can only focus on a relatively small section of the dialysis shunt at the same time. Therefore orientation and documentation arc more difficult [11,12]. MR angiography is largely free of these limitations: it is noninvasive, without the need for exposure to radiation or contrast media, has excellent documentation and re producibility, and involves a short examination time and little irritation for the patient [3,7].…”

Phased Array Coils for Upper Extremity MRA

“…Arterio-venous fistulas are surgically created in the upper extremities of patients undergoing dialysis. However, such fistulas can thrombose and/or create severe hemodynamic disturbances (1)(2)(3). Thus, a diagnostic method to depict the fistula and the adjacent vasculature as well as quantify the flow through the fistula would be very valuable.…”