Abstract
Early detection of pathologic variations in an arteriovenous fistula (AVF) is essential for preventing fistula dysfunction in individuals undergoing hemodialysis. This study aimed to evaluate the clinical applicability of 3-D tomographic ultrasound (tUS) for rapid and simple visualization of AVF morphology and pathology. We assessed 53 AVFs in 50 consecutive patients using 3-D tUS including secondary, blinded reading. For all examinations, a high-end ultrasound (US) device was used with linear probe, attached to a tUS system to allow freehand 3-D scanning. Participants were examined by 2-D US and 3-D tUS with different raw data (B-mode, power Doppler, B-flow). Additional angiography was available for 15 participants with scheduled interventions. In all participants, 3-D tUS allowed a 3-D representation of AVFs in angiographic-like images with good image quality. The 2-D US assessment took 7.9 ± 4.0 min. A 3-D power Doppler scan required, on average, 1.4 ± 0.6 min. Diagnostic accuracy of blinded reading for pathologies was high (86.8% for aneurysms and 79.2% for stenoses). Bland–Altman plots showed an excellent correlation of 3-D tUS with 2-D US and angiography. 3-D tUS is an easily and rapidly applicable method for visualizing morphologic and pathologic AVF variations. Color-coded 3-D reconstruction of power Doppler data simplifies detection of perfused aneurysms and stenoses.
Highlights
Owing to the organ donor shortage, for most people with end-stage renal failure hemodialysis is the method of choice instead of renal transplantation (Gemeinsamer Bundesausschuss 2018)
An applicable, non-invasive and safe diagnostic tool is needed that will allow visualization of the entire course of an arteriovenous fistula (AVF) to guide puncture techniques or perform additional diagnostic and therapeutic workups. In this pre-experimental study, we evaluate the clinical applicability of 3-D tomographic ultrasound for visualizing the morphology and pathology of AVFs in routine assessments and in people with access-related failure
From January to March 2018, 50 consecutive patients with 53 arteriovenous fistulas were recruited from our dialysis unit
Summary
Owing to the organ donor shortage, for most people with end-stage renal failure (approximately 86,000 in Germany in 2017) hemodialysis is the method of choice instead of renal transplantation (Gemeinsamer Bundesausschuss 2018). Dialysis patients with catheters and arteriovenous grafts are especially at risk for complications, such as infections and access dysfunction. The US National Kidney Foundation has highlighted the importance of detecting early fistula dysfunction before thrombosis can Conventional 2-D US plays a key role in assessing AVFs and is well established for initially diagnosing access-related insufficiency of hemodialysis. Doppler sonography provides an excellent tool for real-time imaging in routine assessment and in the initial evaluation of access-related failure in adults and children (Dumars et al 2002; Doelman et al 2005; Thalhammer et al 2007; Visciano et al 2014; Shroff et al 2019; Nalesso et al 2020)
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