The Diagnostic Power of Physical Examination on Surgical Planning for Dialysis Access in Sari Imam Hospital Patients from 2013 to 2014

Abstract

Introduction: It is routine to do physical examination to determine the most suitable place for AV access for haemodialysis. Duplex ultrasonography is a high sensitive modality for the evaluation of vessels and can determine vascular diameter. This study was aimed to evaluate the diagnostic power of physical examination for AV access surgical planning in comparison with Duplex ultrasonography (as the gold standard diagnostic tool). Methods: Physical examination and duplex ultrasonography were done and results were recorded. 117 patients were included on the study. With 95% confidence interval data were analyzed by SPSS 16.0 and sensitivity and specificity of physical examination were calculated. Results: Out of 117 patients, in 60 patients (51.3%), include 33 males and 27 females, physical examination results consistent with Duplex ultrasonography (true positive), with 64.22%, 65% and 86.96% sensitivity, specificity, and positive predictive value, respectively. AVF failure was significantly more observed in snuffbox (forearm) AVF surgery site. Conclusion: Preoperative physical examination can be used initially for patients to evaluate a suitable site for AVF surgery. For better AVF outcome, it’s suggested to perform duplex ultrasonography study in patients with insufficient clinical findings, 60 years and older, BMI 25-30, diabetes, and hypertension.