Hemodialysis access assessment with intravascular ultrasound
Abstract
Reliable identification and treatment of specific hemodialysis access complications may improve access patency and result in significant cost reduction. Angiography is the gold standard for the evaluation of vascular access; however, it has significant limitations. Intravascular ultrasound (IVUS) is a relatively new technique capable of detecting subtle vascular abnormalities. To investigate the safety, feasibility, and accuracy of IVUS imaging to detect hemodialysis access complications, including stenoses, graft deterioration, and thrombus, we performed 31 IVUS imaging studies in 22 hemodialysis patients. Nineteen studies were performed in the dialysis unit, and 12 studies in the angiography suite. The IVUS catheter was inserted into the graft through the access used for hemodialysis. Findings of 21 studies (17 patients) imaged on the same day by both angiography and IVUS were compared. Grafts and vessels were successfully imaged using IVUS in 29 of 31 studies. There were no adverse effects caused by IVUS. Angiography assessed 17 of 54 vessel segments as normal versus 9 of 54 segments by IVUS (P < 0.001). Angiography detected lesions in 25 segments as opposed to 33 segments by IVUS (P < 0.001). A thrombus was detected in 32 o...Continue Reading
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