Stenosis detection in failing hemodialysis access fistulas and grafts: Comparison of color Doppler ultrasonography, contrast-enhanced magnetic resonance.

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Presentation transcript:

Stenosis detection in failing hemodialysis access fistulas and grafts: Comparison of color Doppler ultrasonography, contrast-enhanced magnetic resonance angiography, and digital subtraction angiography Cornelis Doelman, MD, Lucien E.M. Duijm, MD, PhD, Ylian S. Liem, MD, MSc, Clemence L. Froger, MD, Alexander V. Tielbeek, MD, PhD, Astrid B. Donkers-van Rossum, MD, PhD, Philippe W.M. Cuypers, MD, PhD, Petra Douwes-Draaijer, MD, PhD, Jaap Buth, MD, PhD, Harrie C.M. van den Bosch, MD Journal of Vascular Surgery Volume 42, Issue 4, Pages 739-746 (October 2005) DOI: 10.1016/j.jvs.2005.06.006 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 Schematic overview of both access types with the different segmental subdivisions. A radiocephalic arteriovenous fistula (AVF; A) and arteriovenous loop graft (AVG; B) are shown. I, Distal arterial inflow; II, arterial anastomosis; III, loop graft; IV, venous anastomosis (AVG); V, arteriovenous anastomosis (AVF); VI, venous outflow (VI1, forearm; VI2, distal half of the upper arm). Venous outflows comprising the proximal half of the upper arm (VI3) and subclavian vein (VI4) are not shown. Journal of Vascular Surgery 2005 42, 739-746DOI: (10.1016/j.jvs.2005.06.006) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 Semicoronal digital subtraction angiography (A) and three-dimensional contrast-enhanced magnetic resonance angiography (B) of an arteriovenous fistula, surgically revised with a polytetrafluoroethylene graft. Stenoses are seen at the arteriovenous anastomosis (S1), at the distal anastomosis of the graft (S2), and in the brachiocephalic vein (S3). Angulated details of S1 and 2 are shown in (C) and (D). a, Artery; v, vein; sh, sheath. Journal of Vascular Surgery 2005 42, 739-746DOI: (10.1016/j.jvs.2005.06.006) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 3 A digital subtraction angiography (DSA) image (A) shows the introduction of a sheath (Sh) at the location of a stenosis (S) in the venous outflow of an arteriovenous fistula. DSA was complicated by leakage of contrast (white arrow) through the puncture site of a previous hemodialysis. A color Doppler ultrasonography image at the area of narrowing shows a more than 50% diameter reduction of the fistula (B) in combination with spectral broadening due to turbulent flow and increased peak systolic velocity (C). a, Artery; v, vein. Journal of Vascular Surgery 2005 42, 739-746DOI: (10.1016/j.jvs.2005.06.006) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 4 Digital subtraction angiography images show a stenotic lesion (S4) at the entrance of a sheath (Sh) in the arterial part (a) of a loop graft (A). During this procedure, the two stenoses in the venous (v) part of the loop (S1 and S2) and the stenosis at the venous anastomosis (S3) were dilated (B). Access puncture at the venous part of the loop graft was necessary to dilate the stenosis in the arterial part of the graft (S4). The angioplasty result is shown in (C). Journal of Vascular Surgery 2005 42, 739-746DOI: (10.1016/j.jvs.2005.06.006) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions