Hemodialysis access graft stenosis: US detection

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Nephrology

Background:

• Hemodialysis access graft dysfunction is a common complication.
• Accurate diagnosis of stenosis is crucial for maintaining graft patency.
• Conventional diagnostic methods can be invasive.

Purpose of the Study:

• To prospectively assess the sensitivity of ultrasonography (US) in diagnosing stenosis.
• To evaluate US for detecting stenosis in hemodialysis access grafts and their drainage veins.
• To determine the efficacy of US in patients with suspected graft dysfunction.

Main Methods:

• Doppler US and angiography were performed on 38 patients with suspected graft dysfunction.
• Gray-scale, color US, and spectral analysis assessed grafts, anastomoses, and venous outflow.
• Stenosis diagnosis by US used a twofold or higher peak systolic velocity (PSV) elevation criterion.

Main Results:

• Angiography identified 43 stenoses in 34 patients.
• US depicted 92% of stenoses with a 94% positive predictive value.
• A 2- to 2.9-times PSV elevation correlated with ≥75% stenosis; graft flow volume and resistive index did not.

Conclusions:

• Ultrasonography reliably identifies stenoses in hemodialysis access grafts and drainage veins.
• The use of PSV criteria enhances US diagnostic accuracy for graft stenosis.
• US is a valuable, non-invasive tool for evaluating hemodialysis access graft dysfunction.