E. Cavagna et al., Failing hemodialysis arteriovenous fistula and percutaneous treatment: Imaging with CT, MRI and digital subtraction angiography, CARDIO IN R, 23(4), 2000, pp. 262-265
Purpose: To evaluate failing hemodialysis arteriovenous fistulas with helic
al CT angiography (CTA), MR angiography (MRA), and digital subtraction angi
ography (DSA), and to compare the efficacy of the three techniques in detec
ting the number, location, grade, and extent of stenoses and in assessing t
he technical results of percutaneous transluminal angioplasty (PTA) and ste
nting.
Methods: Thirteen patients with Brescia-Cimino arteriovenous fistula malfun
ction underwent MRA and CTA of the fistula and, within 1 week, DSA. A total
of 11 PTAs were performed; in three cases an MR-compatible stent was place
d. DSA served as the gold standard for comparison in all patients. The pres
ence, site, and number of stenoses or occlusions and the technical results
of percutaneous procedures were assessed with DSA, CTA, and MRA.
Results: MRA underestimated a single stenosis in one patient; CTA and MRA d
id not overestimate any stenosis. Significant artifacts related to stent ge
ometry and/or underlying metal were seen in MRA sequences in two cases.
Conclusions: CT and MRT can provide information regarding the degree of vas
cular impairment, helping to stratify patients into those who can have PTA
(single or multiple stenoses) versus those who require an operative procedu
re (occlusion). Conventional angiography can be reserved for candidates for
percutaneous intervention.