Failing hemodialysis arteriovenous fistula and percutaneous treatment: imaging with CT, MRI and digital subtraction angiography.
OBJECTIVE
To evaluate failing hemodialysis arteriovenous fistulas with helical CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA), and to compare the efficacy of the three techniques in detecting the number, location, grade, and extent of stenoses and in assessing the technical results of percutaneous transluminal angioplasty (PTA) and stenting.


METHODS
Thirteen patients with Brescia-Cimino arteriovenous fistula malfunction underwent MRA and CTA of the fistula and, within 1 week, DSA. A total of 11 PTAs were performed; in three cases an MR-compatible stent was placed. DSA served as the gold standard for comparison in all patients. The presence, site, and number of stenoses or occlusions and the technical results of percutaneous procedures were assessed with DSA, CTA, and MRA.


RESULTS
MRA underestimated a single stenosis in one patient; CTA and MRA did not overestimate any stenosis. Significant artifacts related to stent geometry and/or underlying metal were seen in MRA sequences in two cases.


CONCLUSIONS
CT and MRI can provide information regarding the degree of vascular impairment, helping to stratify patients into those who can have PTA (single or multiple stenoses) versus those who require an operative procedure (occlusion). Conventional angiography can be reserved for candidates for percutaneous intervention.
Cavagna
E
E
Department of Radiology, S. Martino Hospital, viale Europa 22, I-32100 Belluno, Italy. enricocavagna@libero.it
D'Andrea
P
P
Schiavon
F
F
Tarroni
G
G
D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure