Failing Arteriovenous Hemodialysis Fistulas

Laissy, Jean-Pierre; Menegazzo, David; Debray, Marie‐Pierre; Loshkajian, Ara; Viron, B; Mignon, Françoise; Schouman-Claeys, É.

doi:10.1097/00004424-199903000-00011

Cited by 21 publications

(3 citation statements)

References 16 publications

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“…Apart from two studies [18,23] about MRA that didn’t use any contrast agents, all other studies applied gadolinium contrast agent for MRA and nonionic iodinated agent for CTA. In terms of the use of contrast agents, the gadolinium contrast agent for MRA does not outweigh the iodinated agent for CTA because both contrast material have side effects.…”

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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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: 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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“…Furthermore, feasibility of non contrast-enhanced MRA has been demonstrated in studies performed on patients with mature failing fistulas, characterized by slow flow. 18,39 …”

Section: Discussionmentioning

confidence: 99%

Vascular Remodeling in Autogenous Arterio-Venous Fistulas by MRI and CFD

et al. 2012

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Hemodynamic parameters play an important role in regulating vascular remodeling in arterio-venous fistula (AVF) maturation. Investigating the changes in hemodynamic parameters during AVF maturation is expected to improve our understanding of fistula failure, but very little data on actual temporal changes in human AVFs is available. The present study aimed to assess the feasibility of using a noncontrast-enhanced MRI protocol combined with CFD modeling to relate hemodynamic changes to vascular remodeling following native AVF placement. MR angiography (MRA) and MR velocimetry (MRV) data was acquired peri-operatively, 1 month, and 3 months later in three patients. Vascular geometries were obtained by segmentation of the MRA images. Pulsatile flow simulations were performed in the patient specific vascular geometries with time-dependent boundary conditions prescribed from MRV measurements. A principal result of the study is the description of WSS changes over time in the same patients. The disturbed flow observed in the venous segments resulted in a variability of the WSS distribution and could be responsible for the non-uniform remodeling of the vessel. The artery did not show regions of disturbed flow upstream from the anastomosis, which would be consistent with the uniform remodeling. MRI use demonstrated the ability to provide a comprehensive evaluation of clinically relevant information for the investigation of upper extremity AVFs. 3D geometry from MRA in combination with MRV provides the opportunity to perform detailed CFD analysis of local hemodynamics in order to determine flow descriptors affecting fistula maturation.

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“…The use of magnetic resonance angiography (MRA) for evaluation of dysfunctioning AVF and AVGs has been described in several studies, but has not been routinely used because of technical and imaging problems (stenosis over-estimation, flow artefacts, limited field of view, etc.) (20-25). However, in the study of Froger et al (25) most of the earlier problems had been overcome due to the evolution of MR angiography technique, with impressive results.…”

Section: Discussionmentioning

confidence: 99%

MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients

Dimopoulou

Raland²,

Wíkström

et al. 2011

Acta Radiol

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Failing Arteriovenous Hemodialysis Fistulas

Abstract: Magnetic resonance angiography is a feasible and sensitive technique with which to portray suspected malfunctioning hemodialysis access fistulas.

Cited by 21 publications

References 16 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

Vascular Remodeling in Autogenous Arterio-Venous Fistulas by MRI and CFD

MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients

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