title: Monitoring and Surveillance of Hemodialysis Vascular Access Using StenTec and Physical Exam.
abstract: Hemodialysis vascular access surveillance for hemodynamically significant stenosis can be a challenge because no universal gold standard exists. The StenTec Gauge measures static intra-access peak pressure and graphically displays the ratio of this pressure to systemic systolic (peak) arterial pressure (PIA ratio). In combination with careful physical exam (PE), the StenTec Gauge is an acceptable and cost-effective way of detecting hemodynamically significant stenosis in arteriovenous fistulas (AVF) or grafts (AVG). In a selected population of 21 hemodialysis patients with mature arteriovenous access, a StenTec reading and physical examination was measured on a weekly basis. Interventional procedures for suspected access dysfunction were performed if there was a greater than 25% increase of the PIA ratio from baseline in two consecutive readings, along with correlating clinical suspicion from physical examination findings. StenTec independently had a sensitivity of 56% and a specificity of 99% in detecting clinically significant stenosis. PE alone had a sensitivity of 89% and a specificity of 100%. StenTec combined with PE had a sensitivity of 100% and a specificity of 99% for predicting hemodynamically significant stenosis. StenTec detected 4 of 10 patients who had a PIA ratio value of ≥0.5, which correlates with current National Kidney Foundation Disease Outcomes Quality Initiative (KDOQI) criteria for mean intra-access pressure ratios indicating a clinically significant outflow stenosis. PE predicted 9 of 10 patients with stenosis, and the combination of StenTec and PE predicted all 10 patients with clinically significant stenosis using the KDOQI criteria for PIA ratio. Hemodynamically significant access stenosis can be detected with excellent accuracy using both StenTec and PE measurements combined for monitoring and surveillance methods.
authors.affiliation: Rancho Los Amigos National Rehabilitation Center, Downey, California; Western University of Health Sciences, Pomona, California.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Dhamija
authors.forename: Shawn K
authors.initials: SK
authors.lastname: Nash
authors.forename: Shawn V
authors.initials: SV
authors.lastname: Nguyen
authors.forename: Kyle
authors.initials: K
authors.lastname: Slack
authors.forename: Joseph
authors.initials: J
authors.lastname: Tadeo
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001794:Blood Pressure; D003251:Constriction, Pathologic / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010808:Physical Examination; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012680:Sensitivity and Specificity; D014654:Vascular Patency