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Stenosis detection in native hemodialysis fistulas with MDCT angiography

Sam Heye1, Geert Maleux, Kathleen Claes

  • 1Department of Radiology, UZ Leuven, University Hospitals Leuven, Herestraat 49, Leuven, 3000 Vlaams-Brabant 3000, Belgium. sam.heye@uzleuven.be

AJR. American Journal of Roentgenology
|March 24, 2009
PubMed

Insights

64-MDCT angiography accurately detects stenosis in failing hemodialysis arteriovenous fistulas (AVFs). This imaging technique is reliable and reproducible for evaluating AVF dysfunction, offering comparable results to digital subtraction angiography (DSA).

Area of Science:

  • Radiology
  • Vascular Imaging
  • Nephrology

Background:

  • Hemodialysis arteriovenous fistulas (AVFs) are crucial for renal replacement therapy.
  • Fistula dysfunction, often due to stenosis or occlusion, can significantly impair treatment efficacy.
  • Accurate diagnostic imaging is essential for timely intervention and management of AVF complications.

Purpose of the Study:

  • To evaluate the diagnostic performance of 64-MDCT angiography in identifying stenosis or occlusion in failing hemodialysis AVFs.
  • To compare the diagnostic value of 64-MDCT angiography with conventional digital subtraction angiography (DSA).

Main Methods:

  • A prospective study involving 36 patients with hemodialysis fistula dysfunction.
  • Patients underwent 64-MDCT angiography followed by DSA.
  • Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were calculated for MDCT angiography against DSA as the reference standard.

Main Results:

  • 64-MDCT angiography demonstrated high accuracy (92.0%), sensitivity (90.2%), and specificity (92.8%) in detecting >/= 50% stenosis or occlusion.
  • Interobserver agreement for stenosis detection was excellent for both MDCT angiography (kappa = 0.82) and DSA (kappa = 0.86).
  • No significant difference in image quality was observed between MDCT angiography and DSA.

Conclusions:

  • 64-MDCT angiography is a reproducible and reliable imaging modality for diagnosing stenosis or occlusion in dysfunctional hemodialysis AVFs.
  • It offers a valuable alternative to DSA for evaluating AVF patency and function.
  • The technique provides excellent diagnostic performance, aiding in the management of hemodialysis access.
Abstract

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