title: Central venous stenosis is more often symptomatic in hemodialysis patients with grafts compared with fistulas.
abstract: OBJECTIVE
  To determine whether hemodialysis patients with central venous stenosis (CVS) are more frequently symptomatic if they have grafts versus fistulas.
  
  
  METHODS
  A retrospective review was performed of 500 consecutive discrete patients, half with fistulas and half with grafts, who had fistulograms performed over a 4-year period. All fistulograms were evaluated for CVS, which was graded into quartiles. The presence of collaterals was noted and graded. Patient records were analyzed for symptoms of CVS, including face, neck, breast, or limb swelling. Statistical analysis was performed to determine the association between access type, degree of stenosis, location of stenosis, and symptoms.
  
  
  RESULTS
  Of 500 fistulograms, 31 were excluded because of inadequate or absent central imaging. Of the remaining 469 patients, 235 had fistulas and 234 had grafts. CVS was present in 51% of patients with fistulas (119 of 237) and 51% of patients with grafts (118 of 237). When CVS was present, 29% (35 of 119) of patients with fistulas were symptomatic versus 52% (62 of 118) of patients with grafts (P = .0005). Overall, only 15% of patients with fistulas in the entire cohort were symptomatic compared with 27% of patients with grafts (P = .002). Sex, access side, and transposition did not influence symptoms; however, patients with upper arm access were more likely than patients with forearm access to be symptomatic (P < .0001), independent of access type.
  
  
  CONCLUSIONS
  CVS is more likely to be symptomatic in patients with grafts versus fistulas, and patients with upper arm access are more likely than patients with forearm access to be symptomatic.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104. Electronic address: streroto@uphs.upenn.edu.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: Shawn
authors.initials: S
authors.lastname: Kothari
authors.affiliation: School of Nursing, Office of Nursing Research, Perelman School of Medicine, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: Therese E
authors.initials: TE
authors.lastname: Sammarco
authors.affiliation: School of Nursing, Office of Nursing Research, Perelman School of Medicine, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Chittams
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology*; D058017:Vascular Grafting / Q000706:statistics & numerical data*