title: Accuracy of physical examination in the detection of arteriovenous graft stenosis.
abstract: Physical examination has recently been demonstrated to detect vascular access stenosis in patients with arteriovenous fistulae. However, its accuracy in the identification of stenoses when compared with the gold standard (angiography) in patients with arteriovenous grafts has not been studied in a systematic fashion. We conducted a prospective study to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. Forty-three consecutive cases referred for an arteriovenous graft dysfunction were included in this analysis. Preprocedure physical examination was performed. The findings of the examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was performed. The images were reviewed by an independent interventionalist with expertise in endovascular dialysis access procedures and the diagnosis was rendered. The reviewer was blinded to the physical examination. Cohen's Kappa was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. There was a strong agreement between the physical examination and the angiography in the diagnosis of vein-graft anastomotic stenosis (kappa = 0.52). The sensitivity and specificity for this lesion was 57% and 89%, respectively. There was a moderate agreement beyond chance regarding the diagnosis of intragraft (kappa = 0.43) and inflow stenoses (kappa = 0.40). The sensitivity and specificity for the intragraft and inflow stenosis was 100%, 73% and 33%, 73%; respectively. The findings of this study demonstrate that physical examination can assist in the detection and localization of stenoses in arteriovenous grafts.
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Leon
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Orozco-Vargas
authors.forename: Gururaj
authors.initials: G
authors.lastname: Krishnamurthy
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Choi
authors.forename: Carlos
authors.initials: C
authors.lastname: Mercado
authors.forename: Donna
authors.initials: D
authors.lastname: Merrill
authors.forename: Ian
authors.initials: I
authors.lastname: Thomas
authors.forename: Loay
authors.initials: L
authors.lastname: Salman
authors.forename: Shukhrat
authors.initials: S
authors.lastname: Artikov
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Bourgoignie
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006083:Graft Occlusion, Vascular / Q000175:diagnosis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D010808:Physical Examination / Q000592:standards*; D006435:Renal Dialysis / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity