Hemodialysis access fistula creation: preoperative assessment with MR venography and comparison with conventional venography.

Abstract

To prospectively evaluate magnetic resonance (MR) venography in the assessment of the adequacy of superficial veins for creation of hemodialysis access fistulas. Twenty-eight upper limbs in 24 patients were imaged with MR and conventional venography. MR venography was performed with sequential multisection two-dimensional fast low-angle shot acquisitions in the axial plane from the wrist through the arm. Two observers independently evaluated MR venograms without knowledge of conventional venographic results. MR and venographic data were compared with each other and with surgical data in 21 patients. Diameters measured on MR and conventional venograms were compared by using linear regression analysis. Qualitative comparisons were performed with the kappa coefficient. Conventional and MR venographic diameter measurements were closely correlated overall (r = 0.91, P < .001) and on a vein-by-vein basis (r = 0.84-0.98, P < .001). MR and conventional venographic results were also well correlated in terms of demonstration of superficial veins (kappa = 0.83). MR venography demonstrated more patent veins than venography did, but the difference was not significant. The correlation between MR venographic and surgical findings (kappa = 0.78) was superior to that between conventional venographic and surgical findings (kappa = 056). MR venography is an accurate, noninvasive technique that is as useful as conventional venography for the planning of hemodialysis access fistula creation.