ACCURACY OF DOPPLER ULTRASOUND IN DIAGNOSING ANATOMIC STENOSIS OF HEMODIALYSIS ARTERIOVENOUS ACCESS AS COMPARED WITH FISTULOGRAPHY

A variety of techniques (physical examination, venous pump pressure, p ercent urea recirculation, Grit Line, Transonic Flow, and others) are helpful in detecting vascular access dysfunction with subsequent refer ral to fistulography for confirmation of stenosis and possible angiopl asty, Although these techniques are adequate, it is not uncommon that the results in some patients may be borderline or equivocal. In these cases, Doppler ultrasound may play a role to confirm the presence or a bsence of significant stenosis before subjecting the patient to the mo re expensive and invasive fistulography, For Doppler ultrasound to pla y such a role, it must have a high degree of accuracy in diagnosing an atomic stenosis. In previous studies, percent stenosis by Doppler ultr asound as compared with percent stenosis by fistulography was examined only when stenosis was suspected, therefore not allowing the determin ation of Doppler ultrasound specificity in diagnosing negative stenosi s when fistulography was negative, In this study, we evaluated 38 hemo dialysis patients with Doppler ultrasound followed by fistulography, w ithout regard to suspicion of stenosis (to access both the sensitivity and specificity of Doppler ultrasound). Nineteen patients (50%) had s ignificant stenosis by fistulography (greater than or equal to 50% nar rowing). The same 19 patients had significant stenosis by Doppler ultr asound (significant stenosis at greater than or equal to 40% with high -velocity flow turbulence or greater than or equal to 50% without turb ulent flow), whereas the remaining patients had no significant stenosi s. In addition, the percent stenosis by Doppler ultrasound had a linea r relationship to the percent stenosis by fistulography, In conclusion , Doppler ultrasound closely correlates to fistulography in diagnosing anatomic stenosis, In patients in whom other techniques for diagnosin g access stenosis show borderline results, Doppler ultrasound may play an adjuvant role to confirm the presence or absence of significant st enosis. (C) 1998 by the National Kidney Foundation, Inc.