Ćosović, A. (2014) The value of duplex ultrasound in detection of stenosis in fistulae with an absolute blood flow <400 ml/min and/or ≥20% decrease. thesis, Medicine.
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Abstract
Background The arteriovenous fistula (AVF) is the most widely used method of vascular access for long-term hemodialysis. A well-functioning mature AVF is essential for the maintenance of hemodialysis in patients with end stage renal disease (ESRD). However, the complication rate related to AVF remains high. The most common cause of fistula failure is thrombosis caused by stenosis. The best predictor for stenosis is a decrease in blood flow. Several imaging modalities are available for evaluation of dysfunctional hemodialysis fistulae. Angiography is the gold standard, and duplex ultrasound is also widely used for detection of access stenoses. Duplex ultrasound is non-invasive and low risk. The purpose of this study was to evaluate the value of duplex ultrasound in detection of significant (≥50%) stenoses in fistulae with an absolute blood flow <400 ml/min and/or ≥20% decrease. Patients and Methods Patients that underwent construction of an AVF in the period of January 1, 2007 until December 31, 2012 at the Scheper Hospital Emmen (SZE) were included in this study. Patients were further selected by duplex ultrasounds requested for a significant change in blood flow rate (flow <400 ml/min and/or ≥20% decrease) measured by transonic flow meter (TFM) in the period of January 1, 2007 until June 30, 2014. Concordance between duplex ultrasound and angiography results were analyzed. Results The study included 227 patients, 55 of which had shown a significant change in blood flow rate and were assessed using duplex ultrasound. In the total group of 55 patients, 102 duplex ultrasounds were made of which 85 (83.3%) detected a significant stenosis. A stenosis was confirmed in 75 of the 85 performed angiographies. The other ten patients had sufficient blood flow or diameter to continue the use of AVF, or underwent surgical revision, or were deceased before angiography could be performed. In the study group, two patients had a negative duplex ultrasound, though angiography had been performed and had detected a significant stenosis. The predictive value of significant change in blood flow in detecting a stenosis in AVF was also investigated. With a sensitivity of 69% and a specificity of 20% the predictive value of significant change in blood flow in finding a stenosis was poor. Conclusion Duplex ultrasound can clearly assess the presence of AVF stenosis after a significant change in blood flow has been detected. It provides information about the location and type of stenosis, as well as the location for injection during percutaneous transluminal angioplasty. It is a non-invasive and safe technique. However, the two negative duplex ultrasounds with positive angiograms can raise debate concerning the value of duplex ultrasound in detecting stenoses. A next study should be a randomized control trial, where duplex ultrasound will be compared with angiography.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Berg, dr. M. van den and Post, S.F. and Scheperziekenhuis Emmen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2546 |
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