64-Slice MDCT Angiography of Upper Extremity in Assessment of Native Hemodialysis Access

Wasinrat, Jitladda; Siriapisith, Thanongchai; Thamtorawat, Somrach; Tongdee, Trongtum

doi:10.1177/1538574410379922

Cited by 12 publications

(17 citation statements)

References 19 publications

(33 reference statements)

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“…The search initially yielded 333 primary studies. Finally there were 16 studies in 15 articles included in the meta-analysis [10-24]. The main reasons for exclusion were as follows: (1) not relevant to CTA or MRA for detecting or evaluating stenosis; (2) unable to create 2×2 table; (3) QUADAS score less than 9.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic Accuracy of Computer Tomography Angiography and Magnetic Resonance Angiography in the Stenosis Detection of Autologuous Hemodialysis Access: A Meta-Analysis

Chen

et al. 2013

PLoS ONE

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PurposeTo compare the diagnostic performances of computer tomography angiography (CTA) and magnetic resonance angiography (MRA) for detection and assessment of stenosis in patients with autologuous hemodialysis access.Materials and MethodsSearch of PubMed, MEDLINE, EMBASE and Cochrane Library database from January 1984 to May 2013 for studies comparing CTA or MRA with DSA or surgery for autologuous hemodialysis access. Eligible studies were in English language, aimed to detect more than 50% stenosis or occlusion of autologuous vascular access in hemodialysis patients with CTA and MRA technology and provided sufficient data about diagnosis performance. Methodological quality was assessed by the Quality Assessment of Diagnostic Studies (QUADAS) instrument. Sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood values (NLR), diagnostic odds ratio (DOR) and areas under the receiver operator characteristic curve (AUC) were pooled statistically. Potential threshold effect, heterogeneity and publication bias was evaluated. The clinical utility of CTA and MRA in detection of stenosis was also investigated.ResultSixteen eligible studies were included, with a total of 500 patients. Both CTA and MRA were accurate modality (sensitivity, 96.2% and 95.4%, respectively; specificity, 97.1 and 96.1%, respectively; DOR [diagnostic odds ratio], 393.69 and 211.47, respectively) for hemodialysis vascular access. No significant difference was detected between the diagnostic performance of CTA (AUC, 0.988) and MRA (AUC, 0.982). Meta-regression analyses and subgroup analyses revealed no statistical difference. The Deek’s funnel plots suggested a publication bias.ConclusionDiagnostic performance of CTA and MRA for detecting stenosis of hemodialysis vascular access had no statistical difference. Both techniques may function as an alternative or an important complement to conventional digital subtraction angiography (DSA) and may be able to help guide medical management.

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Section: Resultsmentioning

confidence: 99%

“…The pregnant, children and patients with renal insufficiency should be suggested to avoid CTA examine because CTA examine exposes the patient to ionizing radiation and iodinated contrast agent [24]. The presence of claustrophobia, pacemaker, and magnetized metal in patients are limited in MR scanner.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Computer Tomography Angiography and Magnetic Resonance Angiography in the Stenosis Detection of Autologuous Hemodialysis Access: A Meta-Analysis

Chen

et al. 2013

PLoS ONE

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“…CTA allows diagnosis of dysfunctional vascular access [47,48] as well as simultaneous visualization of the entire vascular tree [49,50]. Moreover, CTA is capable of diagnosing hemodynamically relevant stenoses or occlusions of dialysis vascular access [50,51]. Moreover, flow-limiting stenoses can be detected also in the case of forearm fistulas with moderate sensitivity and high specificity [52].…”

Section: Computed Tomographymentioning

confidence: 99%

“…Some authors therefore refer to CTA as superior to purely diagnostic DSA for economic reasons [46]. CTA allows diagnosis of dysfunctional vascular access [47,48] as well as simultaneous visualization of the entire vascular tree [49,50]. Moreover, CTA is capable of diagnosing hemodynamically relevant stenoses or occlusions of dialysis vascular access [50,51].…”

Section: Computed Tomographymentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

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A wide variety of diagnostic and minimally invasive modalities is currently available to radiologists for providing sufficient medical care for dialysis patients. In addition to clinical examination, ultrasound is the first line imaging method in suspected dialysis vascular access dysfunction. The percutaneous approach is the primarily recommended therapeutic option in many cases. This article reviews the current diagnostic and therapeutic methods in dialysis vascular access insufficiency. Key Points: ??Vascular access dysfunction is often elicited by stenosed vessels, which are regularly associated with concomitant thrombosis. ??Stenoses are commonly observed in the anastomosis, vascular access vein and also in the central venous system. ??Beside the clinical examination, sonography is the diagnostic method of first choice. ??Percutaneous balloon dilatation frequently is the first treatment option. Citation Format: ??Kamper L, Faizy TD, Haage P. Diagnosis and Treatment of Insufficient Dialysis Vascular Access. Fortschr R?ntgenstr 2015; 187: 360???371

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“…Multidetector row computed tomographic (MDCT) angiography provides excellent correlation in vascular stenosis compared with conventional DSA in HD access. Complete assessment of entire vascular segments could be performed with MDCT angiography in planning before endovascular intervention or surgical correction [48] .…”

Section: Permanent Vamentioning

confidence: 99%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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The number of patients with chronic kidney disease requiring renal replacement therapy has increased worldwide. The most common replacement therapy is hemodialysis (HD). Vascular access (VA) has a key role for successful treatment. Despite the advances that have taken place in the field of the HD procedure, few things have changed with regards to VA in recent years. Arteriovenous fistula (AVF), polytetrafluoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common complications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunction is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the first choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the first choice, followed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most important issue for patients on HD and despite the technical improvements, a number of problems and complications have to be resolved.

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64-Slice MDCT Angiography of Upper Extremity in Assessment of Native Hemodialysis Access

Abstract: MDCT angiography provides excellent correlation in vascular stenosis as compared with DSA in hemodialysis access. Complete assessment of entire vascular segments could be performing with MDCT angiography in planning before endovascular intervention or surgical correction.

Cited by 12 publications

References 19 publications

Diagnostic Accuracy of Computer Tomography Angiography and Magnetic Resonance Angiography in the Stenosis Detection of Autologuous Hemodialysis Access: A Meta-Analysis

Diagnostic Accuracy of Computer Tomography Angiography and Magnetic Resonance Angiography in the Stenosis Detection of Autologuous Hemodialysis Access: A Meta-Analysis

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Vascular access today

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