title: MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients.
abstract: BACKGROUND
  Arteriovenous fistulas and grafts are the methods of choice for vascular access in renal failure patients in need of hemodialysis. Their major complication, however, is stenosis, which might lead to thrombosis.
  
  
  OBJECTIVE
  To demonstrate the usefulness of 16-MDCTA with 3D image reconstructions, in long-term hemodialysis patients with dysfunctional arteriovenous fistulas and grafts (AVF and AVG).
  
  
  METHODS
  During a 17-month period, 31 patients with dysfunctional AVF and AVG (24 AVF and seven AVG) were examined with MDCTA with 3D image postprocessing. Parameters such as comprehension of the anatomy, quality of contrast enhancement, and pathological vascular changes were measured. DSA was then performed in 24 patients.
  
  
  RESULTS
  MDCTA illustrated the anatomy of the AVF/AVG and the entire vascular tree to the heart, in a detailed and comprehensive manner in 93.5% of the evaluated segments, and depicted pathology of AVF/AVG or pathology of the associated vasculature. MDCTA demonstrated a total of 38 significant stenoses in 25 patients. DSA verified 37 stenoses in 24 patients and demonstrated two additional stenoses. MDCTA had thus a sensitivity of 95%. All 24 patients were treated with percutaneous transluminal angioplasty (PTA) with good technical results.
  
  
  CONCLUSIONS
  MDCTA with 3D reconstructions of dysfunctioning AVFs and AVGs in hemodialysis patients is an accurate and reliable diagnostic method helping customize future intervention.
authors.affiliation: Department of Radiology, University Hospital, Uppsala, Sweden. angeliki.dimopoulou@akademiska.se
authors.forename: Angeliki
authors.initials: A
authors.lastname: Dimopoulou
authors.forename: Hans
authors.initials: H
authors.lastname: Raland
authors.forename: Björn
authors.initials: B
authors.lastname: Wikström
authors.forename: Anders
authors.initials: A
authors.lastname: Magnusson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D006435:Renal Dialysis / Q000379:methods