Ultrasonographic diagnosis of stenosis of native arteriovenous fistulas in haemodialysis patients.
OBJECTIVE
Ultrasound (US) examination is an important tool in the diagnosis of arteriovenous (AVF) stenoses; different US measures are available for assessing the severity of stenoses. The aim of our study was to analyse risk factors and consequences of AVF stenosis and its severity and to compare the usefulness of different US measures of stenoses' severity.


METHODS
Ninety-seven prevalent patients from a single dialysis centre with patent AVF were included. We recorded history of disease, clinical and laboratory data. US was used to diagnosis the stenosis and to measure blood flow in the brachial artery, resistivity index (RI), and the diameter of the vessels (arteries, anastomosis, venous outflow).


RESULTS
Stenosis was present in 54.64% of the patients (59.6% juxtaanastomotic). Stenosis patients had higher age, lower diameter of the brachial artery, lower anastomosis diameter, and lower diastolic blood pressure (DBP). Atherosclerosis, delayed maturation of AVF, and statin treatment were more prominent in the stenosis group. Logistic regression disclosed delayed maturation, cholesterol, atherosclerosis, and DBP as significant predictors of stenosis. When severe stenosis was measured by the diameter reduction, stenosis patients had higher age, lower HDL cholesterol, and poorer dialysis efficacy. Flow in the brachial artery and RI were less useful for identifying risk factors or differences in outcome.


CONCLUSIONS
Prevalence of stenosis was high in our cohort, more than half of the patients having some degree of stenosis. Risk factors for stenosis were related to atherosclerosis, low DBP, and delayed maturation of AVF. Diameter of stenosis is the most useful marker of severity.
Department of Nephrology and Dialysis, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. dacian_tirinescu@yahoo.com.
Dacian-Călin
DC
Tirinescu
Department of Informatics and Biostatistics,"Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Cosmina Ioana
CI
Bondor
Department of Nephrology and Dialysis, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Dan Ştefan
DŞ
Vlăduțiu
Nefromed Dialysis Centers, Cluj-Napoca, Romania.
Ioan Mihai
IM
Pațiu
Department of Nephrology and Dialysis, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Diana
D
Moldovan
Nefromed Dialysis Centers, Cluj-Napoca, Romania.
Remus
R
Orășan
Department of Nephrology and Dialysis, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Ina Maria
IM
Kacsó
D000367:Age Factors; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D012307:Risk Factors; D012383:Romania; D012720:Severity of Illness Index; D014463:Ultrasonography