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      Assessment of Occlusion of the Vascular Access in Patients on Chronic Hemodialysis: Comparison of Physical Examination with Continuous-Wave Doppler Ultrasound

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          Abstract

          Background: Dialysis access occlusion is the most common cause of hospitalization and a frequent indirect cause of mortality in patients on chronic hemodialysis. The clinical assessment of an arteriovenous shunt is presently the most widely adopted method for the diagnosis of vascular access occlusion in hemodialysis patients, but no studies have yet investigated objectively its sensitivity and positive predictive value (PPV). Continuous-wave (CW) Doppler ultrasound is a simple, inexpensive, and noninvasive technique for the assessment of arterial blood flow. We have carried out a prospective evaluation of the PPV of CW Doppler for the diagnosis of vascular access occlusion in hemodialysis patients and compared it with clinical investigation. Methods: Fourty-one hemodialysis patients with clinical diagnosis of occlusion of their fistula were studied, and in 23 of them the diagnosis of occlusion was objectively validated. Results: CW Doppler in the patients in whom occlusion was objectively validated showed PPV of 86 and 83% under basal conditions and after fistula compression, respectively, with sensitivities of 95 and 100%, respectively. Clinical diagnosis, under the same conditions, showed a PPV of 83% and a sensitivity of 100%. Conclusions: CW Doppler and clinical examination have a similar high sensitivity for the diagnosis of occlusion of the dialysis access; thus, there is no need to use routinely Doppler CW examination, unless objective documentation is required.

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          Duplex ultrasound scanning in the assessment of arteriovenous fistulas created for hemodialysis access: comparison with digital subtraction angiography.

          The results of duplex ultrasound scanning for the diagnosis of stenoses in Brescia-Cimino arteriovenous fistulas and graft arteriovenous fistulas created for hemodialysis access are reported. Quantitative Doppler spectrum analysis of 64 arteriovenous fistulas was correlated with the outcome of digital subtraction angiography. The best Doppler parameter for the detection of a stenosis was the peak systolic frequency. In graft arteriovenous fistulas the use of this parameter resulted in a diagnostic accuracy of 86%, a sensitivity of 92%, and a specificity of 84% in the detection of stenoses. In Brescia-Cimino arteriovenous fistulas the diagnosis of anastomotic stenoses was possible with a diagnostic accuracy of 81%, a sensitivity of 79%, and a specificity of 84%. Measurement of peak systolic frequency ratios or end-diastolic frequencies had no additional diagnostic value for the detection of stenoses. The diagnosis of efferent vein stenoses was very accurate with duplex investigation (accuracy 96%, sensitivity 95%, and a specificity of 97%. We conclude that duplex scanning is a promising noninvasive method for the diagnosis of stenoses in arteriovenous fistulas created for hemodialysis access.
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            Author and article information

            Journal
            NEF
            Nephron
            10.1159/issn.1660-8151
            Nephron
            S. Karger AG
            1660-8151
            2235-3186
            1999
            May 1999
            28 April 1999
            : 82
            : 1
            : 7-11
            Affiliations
            aDepartment of Internal Medicine, Cortona Hospital, Cortona; bInstitute of Internal and Vascular Medicine, University of Perugia; cChair of Nephrology, University of Modena, Italy
            Article
            45360 Nephron 1999;82:7–11
            10.1159/000045360
            10224477
            © 1999 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 1, Tables: 1, References: 15, Pages: 5
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/45360
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            Original Paper

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