Multi-slice CT angiography versus duplex ultrasound in detection of stenosis of access arteriovenous fistulas and grafts in dysfunctional hemodialysis

Abstract

Purpose: To assess the accuracy of MS-CTA for the detection and grading of stenosis in AVF and AVG in comparison with colored Duplex. Patients and methods: Prospective analysis of vascular access related data was obtained from 30 patients (10 Males, 20 Females and age range 18–62 years) referred from hemodialysis unit for CTA and CDUS examination in upper limbs. Results: There were no statistically significant differences between mean Stenosis%, mean Length of stenosis segment and mean Narrowest part as measured by the two modalities (P-values = 0.115, = 0.271 & = 0.233 respectively). Subclavian vein occlusion: detected in 7 cases (23.3%) by CTA and only 4 out of the 7 cases were detected by Doppler (13.3%). SVC occlusion: not detected by Doppler (0.0%) and detected in 4 cases (13.3%) by CTA. Chest wall venous collateralization: not detected by Doppler (0.0%) and detected in 10 cases (33.3%) by CTA. Innominate vein occlusion: not detected by Doppler (0.0%) and detected in 2 cases (6.7%) by CTA. Conclusions: CDUS by an experienced hand is an adequate diagnostic tool except for evaluation of central veins, whereas, the MSCTA plays an important role as a minimally invasive modality for evaluating the AVFs especially the central veins.

Keywords

• ESRD
• MSCTA
• CDUS
• Hemodialysis
• AVF
• Complications
• Stenosis