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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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          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.

            Author and article information

            S. Karger AG
            May 1999
            28 April 1999
            : 82
            : 1
            : 7-11
            aDepartment of Internal Medicine, Cortona Hospital, Cortona; bInstitute of Internal and Vascular Medicine, University of Perugia; cChair of Nephrology, University of Modena, Italy
            45360 Nephron 1999;82:7–11
            © 1999 S. Karger AG, Basel

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            Page count
            Figures: 1, Tables: 1, References: 15, Pages: 5
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/45360
            Self URI (text/html): https://www.karger.com/Article/FullText/45360
            Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
            Original Paper

            Cardiovascular Medicine,Nephrology
            Vascular access thrombosis,Arterial blood flow,Arteriovenous shunt,Continuous-wave Doppler ultrasound


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