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Michas V, Taghipour M, Papachristodoulou A, Sidiropoulou M, Partovi S, Cokkinos D, Rafailidis V, Gadani S, Gill A, Michell H, Prassopoulos P. Multiparametric ultrasound for upper extremity dialysis access evaluation. Ultrasonography 2023; 42:490-507. [PMID: 37723649 PMCID: PMC10555685 DOI: 10.14366/usg.23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 09/20/2023] Open
Abstract
The evolution of ultrasound (US) techniques has greatly improved the evaluation of many parameters in dialysis vascular access, which is typically achieved through an arteriovenous fistula (AVF) or graft (AVG). These techniques include grayscale B-mode, color Doppler, power Doppler, spectral Doppler, non-Doppler US flow imaging techniques, contrast-enhanced US, and elastography. In conjunction with a patient's medical history and physical examination, US provides crucial information about the native vascular bed prior to the surgical creation of an arteriovenous anastomosis. It also tracks the maturation progress of the newly created AVF or AVG and aids in diagnosing potential complications of the vascular access. These complications include thrombosis, steal syndrome, aneurysms, pseudoaneurysms, hematomas, infection, ischemic neuropathy, exacerbation of preexisting congestive heart failure, and stenosis.
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Affiliation(s)
- Vasileios Michas
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Mehdi Taghipour
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | | | - Maria Sidiropoulou
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Sasan Partovi
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | | | - Vasileios Rafailidis
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Sameer Gadani
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Amanjit Gill
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Hans Michell
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Panos Prassopoulos
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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Pichot O, Diard A, Bosc JY, Abbadie F, Franco G, Mahé G, Sadaghianloo N. Standardized Methodology for Duplex Ultrasound Examination of Arteriovenous Access for Hemodialysis: A Proposal of the French Society of Vascular Medicine and the French-Speaking Society of Vascular Access. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2213-2220. [PMID: 37544830 DOI: 10.1016/j.ultrasmedbio.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
Duplex ultrasound (DUS) is an essential tool for characterizing and monitoring arteriovenous (AV) access for hemodialysis. The aim of the work described here, requested by the French Society of Vascular Medicine in collaboration with the French-Speaking Vascular Access Society, is to propose a standardized methodology for performing and documenting DUS, taking into account the variety of AV access techniques and the problems routinely encountered. A steering committee reviewed the literature and selected the relevant references. A draft was prepared, and all items with missing or conflicting data were submitted to a Delphi consensus. The final document was discussed and approved by all participants. The principles of DUS evaluation of AV access consist of examination of the afferent artery, the anastomosis and the entire venous drainage system. DUS uses B-mode ultrasound, color flow, pulsed wave and power Doppler analysis. DUS can be used in a variety of clinical situations, which can directly influence the methodology of the examination and the interpretation of the results. Blood flow should be assessed as it correlates with the risk of thrombosis. The measurement should be adapted to the different anatomical and hemodynamic conditions encountered. Characterization of stenosis should take into account the residual diameter of the drainage vein and its hemodynamic consequences. Other complications can be assessed with a standardized DUS examination. When performed according to a rigorous methodology, DUS of the AV access allows a comprehensive assessment of its functionality and eliminates the need for further invasive diagnostic procedures.
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Affiliation(s)
- Olivier Pichot
- Department of Vascular Medicine, Groupement Hospitalier Mutualiste, Grenoble, France.
| | - Antoine Diard
- Department of Vascular Medicine, Centre Hospitalier Universitaire Bordeaux, France
| | - Jean-Yves Bosc
- Renal Disease Clinics, AIDER Santé, Hôpital Lapeyronie, Montpellier, France
| | - Fabrice Abbadie
- Department of Vascular Medicine, Centre Hospitalier de Vichy, Vichy, France
| | | | - Guillaume Mahé
- Department of Vascular Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Nirvana Sadaghianloo
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice, Nice, France
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Isaak A, Jörg L, Attigah N, Thalhammer C, Staub D, Aschwanden M, Richarz S. Practical guide of vascular ultrasound in arteriovenous fistulae. VASA 2023; 52:22-28. [PMID: 36412046 DOI: 10.1024/0301-1526/a001040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The use of vascular ultrasound, especially with the increasing prevalence of percutaneous arteriovenous fistulas, has taken a central role as a diagnostic and therapeutic imaging procedure in vascular access creation. The current review article stresses the importance of vascular ultrasound in arteriovenous fistula, from planning to creation to maintenance. It summarises and gives practical guidance regarding sonographic criteria for vascular access procedure planning, the application of vascular ultrasound intraoperatively and during follow-up. Ultrasound education and training modalities to meet high standards of patient care in hemodialysis are presented.
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Affiliation(s)
- Andrej Isaak
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Switzerland.,Vascular and Endovascular Surgery, University Hospital Basel, Switzerland
| | - Luzian Jörg
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Switzerland
| | - Nicolas Attigah
- Vascular and Endovascular Surgery, Triemli Hospital, Zurich, Switzerland
| | | | - Daniel Staub
- Angiology, University Hospital Basel, Switzerland
| | | | - Sabine Richarz
- Vascular and Endovascular Surgery, University Hospital Basel, Switzerland
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Cini A, Galan A, Piquet P. Spontaneous bypass of a haemodialysis return vein stenosis. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:207-209. [PMID: 36344034 DOI: 10.1016/j.jdmv.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Antoine Cini
- Service de médecine interne et de pathologie vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France.
| | - Alexandre Galan
- Service d'imagerie médicale et interventionnelle, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Pierre Piquet
- Service d'imagerie médicale et interventionnelle, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
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Steiner K, Ramanarayanan S, Metcalfe M, Jeevaratnum P, Selvakumar S, Narula A. Ultrasound appearances and histological correlation of native arteriovenous fistula stenoses - A retrospective case series. Semin Dial 2021; 34:224-228. [PMID: 33410525 DOI: 10.1111/sdi.12947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/12/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023]
Abstract
The pathophysiology of haemodialysis arteriovenous fistulae (AVF) stenoses is not fully understood. The aim of this study was to perform histology assessment of stenoses in native AVF and compare and correlate the findings between ultrasound and histology. Intimal medial thickness (IMT) was measured on ultrasound where there was measurable neointimal hyperplasia at the site of stenosis and percentage intimal thickening calculated. Ultrasound findings were then compared with histology analysis of AVF stenoses in nine patients. In this small sample, different sonographic appearances and histology were demonstrated. Ultrasound demonstrated stenoses with neointimal hyperplasia and those with no measurable neointimal hyperplasia. Percentage intimal thickening was between 0% and 100%. The histology of the de novo stenoses (where no previous radiological or surgical procedure was performed) demonstrated stenoses with neointimal hyperplasia, no neointimal hyperplasia and neointimal hyperplasia and fibrosis. The histology findings after percutaneous angioplasty (PTA) demonstrated stenoses with neointimal hyperplasia and fibrosis and a stenosis with an acute inflammatory reaction. The findings in this small sample demonstrated that AVF stenoses are not a uniform group as demonstrated by different sonographic and corresponding appearances at histology. Ultrasound appearances of neointimal hyperplasia appear to correlate with neointimal hyperplasia on histology. These findings warrant further investigation and may have implications for treatment strategies.
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Affiliation(s)
- Kate Steiner
- East and North Herts NHST U.K., The Lister Hospital Stevenage, Corey's Mill Lane, Hertfordshire, UK
| | | | - Matthew Metcalfe
- East and North Herts NHST U.K., The Lister Hospital Stevenage, Corey's Mill Lane, Hertfordshire, UK
| | - Praveen Jeevaratnum
- East and North Herts NHST U.K., The Lister Hospital Stevenage, Corey's Mill Lane, Hertfordshire, UK
| | - Sadasivam Selvakumar
- East and North Herts NHST U.K., The Lister Hospital Stevenage, Corey's Mill Lane, Hertfordshire, UK
| | - Ashish Narula
- East and North Herts NHST U.K., The Lister Hospital Stevenage, Corey's Mill Lane, Hertfordshire, UK
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Conkbayir I, Celtikci P, Ergun O, Durmaz HA. Value of duplex Doppler ultrasonography for the evaluation of dysfunctional hemodialysis access arteriovenous fistulas prior to endovascular interventions. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:503-511. [PMID: 29781153 DOI: 10.1002/jcu.22601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/01/2018] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To demonstrate accuracy of duplex Doppler ultrasonography (DUS) for the evaluation of native-vein arteriovenous fistula (AVF) dysfunction in end-stage renal disease patients. METHODS This retrospective study included 60 patients with dysfunctioning native-vein AVF evaluated with DUS and digital subtraction angiography (DSA) whose results were compared for detection, identification, and localization of AVF lesions. We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DUS and evaluated the agreement between DUS and DSA by the Cohen's kappa coefficient (κ). RESULTS DUS identified correctly 123 of 130 lesions (sensitivity 94.6%, specificity 97.5%, PPV 98.4%, NPV 92%, accuracy of 95.7%). DUS localized correctly 123 of 130 lesions (sensitivity 94.6%, specificity 98.4%, PPV 98.4%, NPV 94.6%, accuracy 96.4%). The κ value was 0.9120 for detection of all lesions (almost perfect agreement). CONCLUSION DUS is a reliable method for the initial evaluation of dysfunctional AVFs, with high sensitivity for detecting and correctly localizing circuit problems.
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Affiliation(s)
- Isik Conkbayir
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Pinar Celtikci
- Department of Radiology, Kars Harakani State Hospital, Kars, Turkey
| | - Onur Ergun
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hasan Ali Durmaz
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Aragoncillo Sauco I, Ligero Ramos JM, Vega Martínez A, Morales Muñoz ÁL, Abad Estébanez S, Macías Carmona N, Ruiz Chiriboga D, García Pajares R, Cervera Bravo T, López-Gómez JM, Manzano Grossi S, Menéndez Sánchez E, Río Gomez J, García Prieto AM, Linares Grávalos T, Garcia Boyano F, Reparaz Asensio LM, Albalate Ramón M, de Sequera Ortiz P, Gil Casares B, Ampuero Mencía J, Castellano S, Martín Pérez B, Conty JLM, Santos Garcia A, Luño Fernandez J. Vascular access clinic results before and after implementing a multidisciplinary approach adding routine Doppler ultrasound. Nefrologia 2018; 38:616-621. [PMID: 29903522 DOI: 10.1016/j.nefro.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A multidisciplinary approach and Doppler ultrasound (DU) assessment for the creation and maintenance of arteriovenous fistulas (AVF) for haemodialysis can improve prevalence and patency. The aim of this study was to analyse the impact of a new multidisciplinary vascular access (VA) clinic with routine DU. MATERIAL AND METHODS We analysed the VA clinic results from 2014 and 2015, before and after the implementation of a multidisciplinary team protocol (vascular surgeon/nephrologist) with routine DU in preoperative mapping and prevalent AVF. RESULTS We analysed 345 and 364 patients from 2014 and 2015 respectively. The number of surgical interventions was similar in both periods (p=.289), with a trend towards an increase in preventive surgical repair of AVF in 2015 (17 vs. 29, p=.098). 155 vs. 169 new AVF were performed in 2014 and 2015, with a significantly lower primary failure rate in 2015 (26.4 vs. 15.3%, p=.015), and a non-significant increase in radiocephalic AVF, 25.8 vs. 33.2% (n=40 vs. 56), p=.159. The concordance between the indication at the clinic and the surgery performed also increased (81.3 vs. 93.5%, p=.001). Throughout 2015 fewer complementary imaging test were requested from the clinic (78 vs. 35, p <.001), with a corresponding reduction in costs (€87,716 vs. €59,445). CONCLUSIONS Multidisciplinary approach with routine DU can improve VA results, with a decrease in primary failure rate, higher likelihood of radiocephalic AVF, better management of dis-functioning AVF and lower radiological test costs.
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Affiliation(s)
| | - José Manuel Ligero Ramos
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - Ángel Luis Morales Muñoz
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | - Diego Ruiz Chiriboga
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Rosario García Pajares
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Teresa Cervera Bravo
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - Soledad Manzano Grossi
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Elena Menéndez Sánchez
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Javier Río Gomez
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | - Fernando Garcia Boyano
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | | | - Beatriz Gil Casares
- Servicio de Nefrología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | - Jara Ampuero Mencía
- Servicio de Nefrología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | | | | | - José Luís Martín Conty
- Facultad de Terapia Ocupacional, Logopedia y Enfermería de Castilla la Mancha, Talavera de la Reina, Toledo, España
| | - Alba Santos Garcia
- Servicio de Nefrología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - José Luño Fernandez
- Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España
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Multi-slice CT angiography versus duplex ultrasound in detection of stenosis of access arteriovenous fistulas and grafts in dysfunctional hemodialysis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Thomas SD, Ip EC, Katib N, Pugh D, Lennox A, Endre Z, Tan E, Ellery C, Varcoe RL. A comprehensive renal vascular access clinic results in improved patient outcomes and reduced costs. ANZ J Surg 2016; 88:185-190. [DOI: 10.1111/ans.13794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/12/2016] [Accepted: 08/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Shannon D. Thomas
- Department of Vascular Surgery; Prince of Wales Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- The Vascular Institute; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Eugenia C. Ip
- Department of Vascular Surgery; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Nedal Katib
- Department of Vascular Surgery; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Debbie Pugh
- Department of Renal Medicine; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Andrew Lennox
- Department of Vascular Surgery; Prince of Wales Hospital; Sydney New South Wales Australia
- The Vascular Institute; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Zoltan Endre
- Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- Department of Renal Medicine; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Elaine Tan
- Performance Management Information Unit; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Chris Ellery
- Performance Management Information Unit; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Ramon L. Varcoe
- Department of Vascular Surgery; Prince of Wales Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- The Vascular Institute; Prince of Wales Hospital; Sydney New South Wales Australia
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Elevated Peak Systolic Velocity and Velocity Ratio from Duplex Ultrasound are Associated with Hemodynamically Significant Lesions in Arteriovenous Access. Ann Vasc Surg 2016; 35:68-74. [DOI: 10.1016/j.avsg.2016.01.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/17/2016] [Accepted: 01/26/2016] [Indexed: 11/19/2022]
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Itoga NK, Ullery BW, Tran K, Lee GK, Aalami OO, Bech FR, Zhou W. Use of a proactive duplex ultrasound protocol for hemodialysis access. J Vasc Surg 2016; 64:1042-1049.e1. [PMID: 27183858 DOI: 10.1016/j.jvs.2016.03.442] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/17/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Arteriovenous fistula (AVF) creation is the preferred approach for hemodialysis access; however, the maturation of AVFs is known to be poor. We established a proactive early duplex ultrasound (DUS) surveillance protocol for evaluating AVFs before attempted access. This study determined the effect of this protocol related to improving AVF maturation. METHODS From 2008 to 2013, 153 patients received new upper extremity AVFs and an early DUS surveillance protocol at a single academic institution. The protocol involved an early DUS evaluation before hemodialysis cannulation of the AVF at 4 to 8 weeks after AVF creation. A positive DUS result was identified as a peak systolic velocity of >375 cm/s or a >50% stenosis on gray scale imaging, along with decreased velocity in the outflow vein. Patients with positive DUS findings underwent prophylactic endovascular or open intervention to assist with AVF maturation. Nature of secondary interventions, as well as AVF patency and maturation, were assessed. Overall clinical outcomes and fistula patency were investigated. RESULTS During the study period, 183 upper extremity AVFs were created in 153 patients, including 82 radiocephalic, 63 brachiocephalic, and 38 brachiobasilic AVFs. A mortality rate of 43% (n = 66) was observed in a median follow-up period of 34.5 months (interquartile range, 19.6-46.9). A total of 164 early DUS were performed at a median of 6 weeks (interquartile range, 3.4-9.6 weeks) after the initial creation. Early DUS showed nine AVFs were occluded and were excluded from further analysis. Hemodynamically significant lesions were found in 62 AVFs (40%); however, only 17 (11%) were associated with an abnormal physical examination. Positive DUS finding prompted a secondary intervention in 81% of the patients. Among those with positive early DUS findings, AVF maturation was 70% in those undergoing a secondary intervention compared with 25% in those not undergoing a prophylactic intervention (P = .011). Primary-assisted patency for AVFs with early positive and negative DUS findings were 83% and 96% at 6 months, 64% and 89% at 1 year, and 52% and 82% at 2 years, respectively (P < .001). CONCLUSIONS Early DUS surveillance of AVFs before initial access is reasonable to identify problematic AVFs that may not be reliably detected on clinical examination. Although DUS criteria for AVFs have yet to be universally accepted, proactive early postoperative DUS interrogation assists in the early detection of dysfunctional AVFs and improvement of fistula maturation. Despite improved patency in those with positive DUS findings who undergo prophylactic secondary intervention, overall patency remains inferior to those without an abnormality detected on early DUS imaging.
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Affiliation(s)
- Nathan K Itoga
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - Brant W Ullery
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - Ken Tran
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - George K Lee
- Division of Vascular Surgery, Stanford University, Stanford, Calif; Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Oliver O Aalami
- Division of Vascular Surgery, Stanford University, Stanford, Calif; Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Fritz R Bech
- Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Wei Zhou
- Division of Vascular Surgery, Stanford University, Stanford, Calif; Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif.
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12
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Cowan D, Smith L, Chow J. Maintaining a viable vascular access for hemodialysis in an elderly person with diabetes: a journey to live, not just to stay alive. Clin Case Rep 2016; 4:203-8. [PMID: 26862425 PMCID: PMC4736524 DOI: 10.1002/ccr3.459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/02/2015] [Accepted: 10/26/2015] [Indexed: 12/03/2022] Open
Abstract
The longevity of a successful vascular access (VA) is enhanced when the care of the patient's VA is the responsibility of everyone involved, including the patient and their family. A family nursing perspective enhances VA care outcomes and increases quality of life and well‐being for patients requiring hemodialysis.
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Affiliation(s)
- Debi Cowan
- Renal Services Central Coast Local Health District (CCLHD) Holden Street Gosford New South Wales 2250 Australia; Nursing & Midwifery School of Health Sciences University of Tasmania Locked Bag 1322 Launceston Tasmania 7250 Australia
| | - Lindsay Smith
- Nursing & Midwifery School of Health Sciences University of Tasmania Locked Bag 1322 Launceston Tasmania 7250 Australia
| | - Josephine Chow
- Clinical Innovation & Business Unit South Western Sydney Local Health District Don Everett Building, Locked Bag 7103, BC 1871 Liverpool New South Wales 2170 Australia
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Evaluation of Percutaneous Transluminal Angioplasty Screening using Color Doppler Ultrasonography. J Vasc Access 2015; 16 Suppl 10:S53-7. [DOI: 10.5301/jva.5000448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Well-functioning vascular access is important in hemodialysis patients. The aim of this study was to assess stenosis using color Doppler ultrasonography as well as to investigate a possible association between the need for percutaneous transluminal angioplasty and hemodynamic parameters. Methods A prospective study of the medical records of color Doppler ultrasonography routine examinations of 372 patients was conducted at a dialysis satellite clinic in Japan. Data were analyzed using logistic regression analysis and the receiver operating characteristic curve. The cutoff point for hemodynamic parameters was determined to explore the predictors of percutaneous transluminal angioplasty. Results Logistic regression analysis showed that brachial artery flow volume, brachial artery resistance index and puncture point flow volume divided by the quantity of dialysis blood flow rate were independently associated with percutaneous transluminal angioplasty. Brachial artery resistance index over 0.61, brachial artery blood flow volume under 665 mL/min and puncture point flow volume divided by dialysis blood flow rates under 1.25 were predictive values of the need for percutaneous transluminal angioplasty. Conclusions These parameters could be used as markers for assessing percutaneous transluminal angioplasty risk in hemodialysis patients.
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Swinnen J, Lean Tan K, Allen R, Burgess D, Mohan IV. Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis. J Vasc Surg 2015; 61:436-42. [DOI: 10.1016/j.jvs.2014.05.097] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/31/2014] [Indexed: 11/29/2022]
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Factors Associated with Patency Following Angioplasty of Hemodialysis Fistulae. J Vasc Interv Radiol 2014; 25:1419-26. [DOI: 10.1016/j.jvir.2014.05.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 11/19/2022] Open
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16
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Cansu A, Soyturk M, Ozturk MH, Kul S, Pulathan Z, Dinc H. Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts. Eur J Radiol 2013; 82:1436-43. [DOI: 10.1016/j.ejrad.2013.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 02/15/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
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17
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Visciano B, Riccio E, De Falco V, Musumeci A, Capuano I, Memoli A, Di Nuzzi A, Pisani A. Complications of Native Arteriovenous Fistula: The Role of Color Doppler Ultrasonography. Ther Apher Dial 2013; 18:155-61. [DOI: 10.1111/1744-9987.12073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bianca Visciano
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Eleonora Riccio
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | | | - Antonino Musumeci
- Department of Cardiac Surgery; Federico II University of Naples; Naples Italy
| | - Ivana Capuano
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Andrea Memoli
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Antonella Di Nuzzi
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Antonio Pisani
- Department of Nephrology; Federico II University of Naples; Naples Italy
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Duplex ultrasound volumetric flow analysis before and after hemodialysis in patients with brachio-cephalic fistulae. J Vasc Access 2013; 14:342-7. [PMID: 23661143 DOI: 10.5301/jva.5000150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The United Kingdom Renal Association recommends duplex ultrasound to monitor arteriovenous fistula (AVF) flow rates during surveillance. Significant flow rate changes should prompt further investigation or treatment to avoid a failing fistula. Hemodialysis is known to alter the hemorrheologic and physiologic factors with a potential impact on measured flow rates. The aim of this study was to determine the difference in flow rate measured with duplex ultrasound before and after a single hemodialysis session in patients with brachial-cephalic fistulae. METHODS Patients with brachial-cephalic AVFs in our dialysis populations who were undergoing regular hemodialysis without recent intervention (less than six weeks) were invited to participate. Flow measurements were made pre-and post-hemodialysis using a Zonare ultrasound machine. The vascular scientist was always blinded to the pre-hemodialysis flow. RESULTS A total of 157 patients were identified with brachial-cephalic fistulae. Following exclusions, 119 patients were eligible. However, a further 58 were excluded because they declined or did not attend leaving 61 patients in the study. Paired t test showed a statistically significant reduction in flow rate of 105 mL/min (P=0.026) post-hemodialysis which equates to a -6.9% change in flow (95% C.I. -12.7 to -0.8%). Bland-Altman analysis showed limits of flow rate agreement between -599 mL/min and +810 mL/min (+/-1.96 s.d.). CONCLUSIONS Whilst we have shown a statistically significant change in flow rate post-hemodialysis, this is small and should be taken in the context of previously accepted interobserver variability. Therefore, the practical and financial considerations of implementing an AVF surveillance programme are likely to outweigh the minimal benefit of consistency that would be enabled by strict protocol of pre-hemodialysis flow measurements.
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Vardza Raju A, Kyin May K, Htet Zaw M, Capistrano Canlas C, Hannah Seah M, Menil Serrano C, Hartman M, Ho P. Reliability of ultrasound duplex for detection of hemodynamically significant stenosis in hemodialysis access. Ann Vasc Dis 2013; 6:57-61. [PMID: 23641285 DOI: 10.3400/avd.oa.12.00056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/07/2012] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the accuracy of AVF and AVG duplex ultrasound (US) compared to angiographic findings in patients with suspected failing dialysis access. MATERIALS AND METHODS From July 2008 to December 2010, US was performed on 35 hemodialysis patients with 51 vascular accesses having clinical feature or dialysis parameter suspicious of access problem. Peak systolic velocity ratio of ≥2 was the criteria for diagnosing stenosis ≥50%. Fistulogram was performed in all these patients. Results of US and fistulogram were compared using Kappa and Receiver Operator Characteristic (ROC) analyses. RESULTS In 51 accesses (35 AVF, 16 AVG), US diagnosed significant stenosis in 45 accesses according to the criteria and angiogram confirmed 44 significant stenoses. In AVF lesions, Kappa was 0.533 with 93.3% sensitivity and 60% specificity for US whereas in AVG lesions, Kappa was 0.636 with 100% sensitivity and 50% specificity. Overall Kappa value of 0.56 meant fair to good agreement. ROC demonstrated area under the curve being 0.79 for all cases and was significant (p = 0.016). Using the ≥50% criteria for stenosis diagnosed by US yielded the best sensitivity (95.5%) and specificity (57.1%). CONCLUSION Duplex ultrasound study, using ≥50% criteria, is a sensitive tool for stenosis detection in patients with suspected failing AVF and AVG.
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Affiliation(s)
- Ashvin Vardza Raju
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Fox D, Amador F, Clarke D, Velez M, Cruz J, Labropoulos N, Ryan M, Gelman L. Duplex Guided Dialysis Access Interventions can be Performed Safely in the Office Setting: Techniques and Early Results. Eur J Vasc Endovasc Surg 2011; 42:833-41. [DOI: 10.1016/j.ejvs.2011.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 04/12/2011] [Indexed: 11/17/2022]
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Fahrtash F, Kairaitis L, Gruenewald S, Spicer T, Sidrak H, Fletcher J, Allen R, Swinnen J. Defining a significant stenosis in an autologous radio-cephalic arteriovenous fistula for hemodialysis. Semin Dial 2011; 24:231-8. [PMID: 21517992 DOI: 10.1111/j.1525-139x.2011.00861.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The current definition of a significant stenosis in an autologous arteriovenous fistula (aAVF), the percentage narrowing compared with the adjacent "normal" vessel, is inaccurate. We believe a significant stenosis in the aAVF is an absolute minimal luminal diameter determined by the requirements of the hemodialysis pump. To determine what absolute diameter constitutes a hemodynamically significant stenosis in a radio-cephalic autologous arteriovenous fistula (RC aAVF), the minimal luminal diameter of dysfunctional RC aAVF was compared to that of functional RC aAVF using grayscale and color ultrasound. There were 93 fistulas in study group and 77 in control group. The mean minimum luminal diameter in study group was significantly lower than in control group (2.19 vs. 4.71 mm, p 0.001). With a cutoff value of 2.7 mm, there was 90% sensitivity and 80% specificity in distinguishing functional fistula from dysfunctional fistula. The area under the receiver-operator curve was 90% (CI 84-94%), indicating that a 2.7 mm diameter is accurate in discriminating functional from dysfunctional fistulas. An absolute minimal luminal diameter of 2.7 mm, as determined with grayscale and color ultrasound, is a useful cutoff for defining significant stenosis in a RC aAVF.
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Swinnen J. Duplex ultrasound scanning of the autogenous arterio venous hemodialysis fistula: a vascular surgeon's perspective. Australas J Ultrasound Med 2011; 14:17-23. [PMID: 28191099 PMCID: PMC5024883 DOI: 10.1002/j.2205-0140.2011.tb00181.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jan Swinnen
- Department of Vascular Surgery Westmead Hospital Westmead New South Wales 2145 Australia
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