Three-dimensional contrast-enhanced magnetic resonance angiography (3-D CE-MRA) in the evaluation of hemodialysis access complications, and the condition of central veins in patients who are candidates for hemodialysis access.
BACKGROUND
Arteriovenous (AV) fistulas are crucial in patients requiring long-term hemodialysis (HD). Dysfunctions of these fistulas are the most common causes of recurrent hospitalizations. This study aimed to evaluate the feasibility, safety and usefulness of contrast-enhanced magnetic resonance angiography (CE-MRA) in the evaluation of HD fistulas complications, and the condition of the central veins before HD access.


METHODS
This study comprised 30 consecutive patients (15 females, 15 males; age range 25-66 yrs, mean +/- SD 51.2 +/- 9.9 yrs). Of 30 patients, 26 had native AV fistulas and the remaining four patients, who had a history of previous subclavian vein catheterization, were candidates for HD fistulas. Nine patients had a radiocephalic fistula, 15 had a brachiobasilic fistula, one had a saphenous vein graft, and one had brachiobasilic vein transposition. To observe the fistula complications in these cases, three-dimensional (3-D) CE-MRA using gadolinium was performed.


RESULTS
The results were considered normal in three patients (10%), who were candidates for AV fistula construction; one patient had central vein occlusion due to previous catheterization. Thirteen patients (43.3%) had venous stenosis or occlusion; three of them (10%) had low CE arteries distal to fistula region, leading to ischemic complications, and six (20%) had stenosis at the fistula region. Seven patients (23.3%) had venous pseudoaneurysms, whereas two of them had both pseudoaneurysms and fistula region stenosis, and one had both venous stenosis and pseudoaneurysm. There were no adverse or allergic-like reactions or heat and taste sensations observed in our series.


CONCLUSIONS
3-D CE-MRA is a useful, safe and a practical imaging modality in complicated fistula diagnosis with fewer complications and side-effects in comparison to fistulography.
Paksoy
Yahya
Y
Ultra Görüntüleme Merkezi (Private Imaging Center), Konya, Turkey. yahyapaksoy@yahoo.com
Gormus
Niyazi
N
Tercan
Mehmet Akif
MA
D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000175:diagnosis; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D013350:Subclavian Vein / Q000473:pathology; D013382:Subtraction Technique; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA