VALUE OF MDCT IN THE ASSESSMENT OF ARTERIOVENOUS FISTULAS DYSFUNCTION

Landolsi M.* and Kouki S.

ABSTRACT

Introduction: Arteriovenous fistula dysfunction is a common problem in patients undergoing hemodialysis. Its early diagnosis has a great impact on the prognosis. Physical examination and ultra sonography are usually used to depict fistula stenoses or thromboses. In most cases conventional angiography is performed to evaluate the fistula and the venous outflow segments. It is considered as the method of choice allowing an accurate description of abnormalities. Nevertheless, it is an invasive exam with considerate risk of complication. Recent development in imaging techniques revealed a good accuracy of MDCT angiography as a non invasive reliable tool evaluating the entire vascular tree. Objective: The aim of this study was to demonstrate the accuracy of 64-MDCT angiography in the assessment of arteriovenous fistula dysfunction in comparison with conventional angiography. Subjects and methods: Prospective study including 40 patients (22 men and 18 women), average age 62.4 years with chronic renal insufficiency in the stage of hemodialysis presenting fistula’s dysfunction. All patients underwent conventional angiography first and then 64 row MDCT angiography. CT Images were interpreted by a long experienced radiologist unaware of the results of the angiography. Results: Images quality was good for both exams. MDCT had good accuracy in the depiction of arterial and central venous stenosis. It was even superior to conventional angiography for the depiction of distal venous stenosis. MDCT was also superior to fistulography in the detection of aneurysm thromboses. Conclusion: MDCT angiography is a non invasive imaging tool exploring arteriovenous fistulas failure with reliable results compared to digital substraction angiography.

Keywords: Arteriovenous fistula, fistulography, MDCT angiography.