1. MDCT Angiography for Evaluation of the Complete Vascular Tree of Hemodialysis Fistulas
- Author
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Chi Hsiung Lee, Tze Yu Lee, Shu-Hang Ng, Fan Yen Lee, Chung Cheng Huang, Shyr Ming Sheen-Chen, Ming Jang Hsieh, Min Chi Chen, and Sheung Fat Ko
- Subjects
Adult ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.medical_treatment ,Fistula ,Anastomosis ,Statistics, Nonparametric ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Polytetrafluoroethylene ,Aged ,Mdct angiography ,medicine.diagnostic_test ,business.industry ,Graft Occlusion, Vascular ,Angiography, Digital Subtraction ,General Medicine ,Digital subtraction angiography ,Middle Aged ,medicine.disease ,Thrombosis ,Angiography ,cardiovascular system ,Feasibility Studies ,Female ,Hemodialysis ,Radiology ,Central veins ,Tomography, X-Ray Computed ,business - Abstract
The purpose of our study was to assess the clinical feasibility of MDCT angiography for evaluating hemodialysis arteriovenous fistulas (AVFs).MDCT angiography of the complete vascular trees of 36 failing AVFs or AVF-related complications (20 native and 16 polytetrafluoroethylene graft AVFs) was reviewed. The numbers and degrees of stenoses at the anastomoses, graft loops, and draining and central veins and the presence of aneurysms or thrombosis were recorded. Wilcoxon's signed rank test was used to compare the findings of MDCT angiography with those of digital subtraction angiography (DSA) (n = 10), surgery (n = 22), or both (n = 4) performed within 2-6 days. Kappa statistics were used to correlate the clinical feasibility of MDCT angiography assessed by two reviewers.Among the 14 AVFs examined with both MDCT angiography and DSA, no significant difference was seen in the detection and grading (p = 0.317 to0.999) of stenoses at various segments of the entire vascular tree. Among the 36 AVFs examined, MDCT angiography also showed no significant difference from DSA or surgery in revealing vascular stenoses, aneurysms, and thromboses from the supplying artery to central veins (p = 0.317 to0.999). Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of MDCT angiography in lesion detection were 98.7%, 97.5%, 98.8%, 97.2%, and 98.3%, respectively. High image quality with superb interobserver correlation (kappa = 0.809 to0.999) validated the clinical feasibility of MDCT angiography for assessing AVFs.MDCT angiography is clinically feasible for evaluating the complete vascular tree of failing AVFs and in showing uncommon complications, including brachial aneurysms and central vein lesions.
- Published
- 2005