Evaluation of clinical examination preceding surgical treatment of AV-fistula problems. Is angiography necessary?
Clinical and angiographic findings at preoperative assessment were compared in a prospective investigation of 34 consecutive uraemic patients with problems of vascular access. The series comprised 26 patients with malfunctioning arteriovenous fistulas (AVF) and 8 who were about to receive a new AVF. The diagnostic sensitivity and specificity of clinical examination in malfunctioning AVF were, respectively, 50 and 100% in cases with significant stenosis upstream from the cannulation site (inflow restriction). The corresponding figures in cases with significant stenosis or vein occlusion downstream from the cannulation site (outflow restriction) were 38 and 43%. Clinical disclosure of outflow restriction is considerably impeded when there is concurrent inflow restriction. The advantages and disadvantages of the most commonly used angiographic techniques are discussed.
D000328:Adult; D000368:Aged; D000792:Angiography; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D014511:Uremia / Q000628:therapy