Contrast-enhanced magnetic resonance angiography findings prior to hemodialysis vascular access creation: a prospective analysis.
OBJECTIVE
To determine prospectively the clinical value of contrast-enhanced magnetic resonance angiography (CE-MRA) for assessment of the arterial inflow and venous outflow prior to vascular access (VA) creation.


METHODS
Seventy-three patients underwent duplex ultrasonography (DUS) and CE-MRA prior to VA creation for detection of stenoses and occlusions. Two observers read the CE-MRA images for determination of inter-observer agreement. A VA was considered functional if it could be used for successful two-needle hemodialysis therapy within 2 months after creation.


RESULTS
CE-MRA detected 6 stenosed, 8 occluded arterial vessel segments and 12 stenosed and 41 occluded venous vessel segments in 70 patients. Inter-observer agreement for detection of upper extremity arterial and venous stenoses and occlusions with CE-MRA was substantial to almost perfect (kappa values 0.76-0.96). CE-MRA detected lesions, not detected by DUS, that were associated with VA early failure and non-maturation in 33% of patients (7/21). Accessory veins detected preoperatively were the cause of VA non-maturation in a substantial group of patients (47%: 7/15).


CONCLUSIONS
CE-MRA enables accurate detection of upper extremity arterial and venous stenosis and occlusions prior to VA creation. Preoperative CE-MRA identified arterial and venous stenoses, not detected by DUS that were associated with VA early failure and non-maturation. However, the use of gadolinium containing contrast media is currently contraindicated due the reported incidence of nephrogenic systemic fibrosis.
Planken
R N
RN
Department of Vascular Surgery, Maastricht University Hospital, Maastricht University Medical School, Maastricht, The Netherlands. nilsplanken@gmail.com
Leiner
T
T
Nijenhuis
R J
RJ
Duijm
L E
LE
Cuypers
P W
PW
Douwes-Draaijer
P
P
Van Der Sande
F M
FM
Kessels
A G
AG
Tordoir
J H M
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D001166:Arteriovenous Shunt, Surgical; D003251:Constriction, Pathologic; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D006435:Renal Dialysis; D015203:Reproducibility of Results; D017211:Treatment Failure; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency
D003287:Contrast Media