HEMODIALYSIS ACCESS STENOSIS - EARLY DETECTION WITH COLOR DOPPLER US

PURPOSE: To evaluate color Doppler ultrasound (US) in detection of sub clinical stenosis of hemodialysis access grafts and fistulas. MATERIAL S AND METHODS: Doppler US was performed in 40 consecutive patients wit h no clinical or laboratory findings of hemodialysis access dysfunctio n. To assess the presence and percentage of stenosis, the maximum syst olic blood velocity and velocity ratios were measured and the US image s were assessed visually. Fistulography was recommended in patients wh o demonstrated stenosis greater than 50% at US. RESULTS: At US, 32 of the 40 patients had evidence of stenosis greater than 50%. In 23 of th e 32 patients, a follow-up fistulgram was obtained. Hemodynamically si gnificant stenosis was confirmed in 19 of the 23 patients at fistulogr aphy. Percutaneous transluminal angioplasty was then performed in 18 o f the 19 patients and was successful. CONCLUSIONS: Color Doppler US is more sensitive than clinical or laboratory methods for detection of h emodialysis access stenosis. Screening with US appears to enable earli er detection and therapy.