Angiographic mapping of AV fistula related vascular complications in ESRD via multislice CT; adjuvant role in correlation with CDUS

Abstract

Background: To evaluate the role and usefulness of Multislice CT angiography (CTA) and color Doppler US (CDUS) in assessment of vascular tree of AVFs and comprehensive evaluation of possible shunt complications in ESRD patients on hemodialysis. Methods: Prospective analysis of vascular access related data was obtained from 30 patients (10 Male, 20 Female and age range 18–80 years) referred from hemodialysis unit via CTA and CDUS examination of the upper limbs. All patients were examined to identify the different types of fistula shunt related complications utilizing Doppler indices (PSV, EDV and RI) and different CTA 2D image reconstruction and 3D volume rendering techniques followed by surgical procedures as a gold standard within 2–7 days. Results: The study showed 15 patients with shunt related complications; aneurysm 33.3% (10 patients) followed by venous thrombosis 23.3% (7 patients), and arterial steal syndrome 13.3% (4 patients), and finally venous hypertension 6.6% (2 patients). Considering surgery as a gold standard the sensitivity and specificity of CDUS and CTA, in detecting aneurysms and stenosis was 100% and 100% respectively. The detection of subclavian occlusion sensitivity and specificity by CDUS was 70% and 85% respectively on the other hand CTA sensitivity and specificity was 100% and 100% respectively. Conclusions: The adjuvant diagnostic value of CTA with CDUS maximizes the evaluation of AV fistula related vascular complications approaching that of surgery.

Keywords

• ESRD
• CTA
• CDUS
• Hemodialysis
• AVF and Complications