Multislice Computed Tomographic Angiography in Evaluating Dysfunction of the Vascular Access in Hemodialysis Patients

Ye, Chaoyang; Zhiguo, Mao; Shu, Rong; Zhang, Yuqiang; Mei, Changlin; Li, Huimin; Dong, Shaohong

doi:10.1159/000093996

Cited by 24 publications

(16 citation statements)

References 18 publications

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“…Recently, findings of AV fistula stenosis using multislice computerized tomography (CT) angiography were shown to correlate well with those obtained by DSA 109. Ko et al 110 reported that multidetector CT had high sensitivity compared with DSA in detecting stenotic lesions in AV fistulas and grafts.…”

Section: Imaging Nhmentioning

confidence: 87%

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Terry

Shiu

et al. 2008

Kidney International

113

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Stenosis is a major cause of failure of hemodialysis vascular grafts and is primarily caused by neointimal hyperplasia (NH) at the anastomoses. The objective of this article is to provide a scientific review of the biology underlying this disorder and a critical review of the state-of-the-art investigational preventive strategies in order to stimulate further research in this exciting area. The histology of the NH shows myofibroblasts (that are probably derived from adventitial fibroblasts), extracellular matrices, pro-inflammatory cells including foreign-body giant cells, a variety of growth factors and cytokines, and neovasculature. The contributing factors of the pathogenesis of NH include surgical trauma, bioincompatibility of the synthetic graft, and the various mechanical stresses that result from luminal hypertension and compliance mismatch between the vessel wall and graft. These mechanical stimuli are focal in nature and may have a significant influence on the preferential localization of the NH. Novel mechanical graft designs and local drug delivery strategies show promise in animal models in preventing graft NH development. Successful prevention of graft stenosis would provide a superior alternative to the native fistula as hemodialysis vascular access.

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Section: Imaging Nhmentioning

confidence: 87%

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Terry

Shiu

et al. 2008

Kidney International

113

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“…CTA can provide important information for the further course of treatment also for recommended operative and interventional procedures. 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].…”

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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“…However, it could be argued that stenoses are more difficult to grade during surgery, and that surgery will not offer a detailed inspection of a larger area. Ye et al (15) used 16-MDCTA to examine 22 patients with dysfunctional AVFs. Of the 19 patients found to have significant stenoses, five proceeded to DSA whereas 11 were surgically revised.…”

Section: Discussionmentioning

confidence: 99%

“…It can require multiple contrast injections and depending on the depicted pathology, a second puncture site might be needed for a successful percutaneous transluminal angioplasty (PTA) . There has therefore been a growing need for a noninvasive, accurate, and simple method in order to diagnose pathology in dysfunctional AVFs and AVGs. Multidetector CT angiography (MDCTA) has been applied in such a setting with predominantly good results (12)(13)(14)(15)(16) and its use and clinical benefits have been presented earlier by our group in international meetings (17,18).…”

mentioning

confidence: 99%