Failing hemodialysis arteriovenous fistula and percutaneous treatment: Imaging with CT, MRI and digital subtraction angiography

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.