Screening for dialysis access graft malfunction: comparison of physical examination with US.
OBJECTIVE
To test the reliability and performance of two physical diagnosis algorithms for use in physical examination of vascular access grafts.


METHODS
Grafts were assessed in 39 patients by means of physical examination performed by four observers. Grafts were characterized as having a thrill, pulse, or indeterminate examination at three locations (arterial, midpoint, venous). Findings with this algorithm were compared with those from ultrasound (US) with volume flow measurements.


RESULTS
Patients with a thrill at all three locations of the graft all had volume flows greater than 450 mL/min (negative predictive value = 100%). Of patients with a pulse at any of three locations, only 28% (positive predictive value) had a volume flow of 450 mL/min or less.


CONCLUSIONS
Physical examination is a good screening test for ruling out the low flows associated with impending access graft failure, thereby eliminating the need for routine US for many patients.
Trerotola
S O
SO
Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Scheel
P J
PJ
Powe
N R
NR
Prescott
C
C
Feeley
N
N
He
J
J
Watson
A
A
D000328:Adult; D000368:Aged; D000465:Algorithms; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011138:Polytetrafluoroethylene; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D011138:Polytetrafluoroethylene