Publication: Indications for fistulography and correlation with detection of arteriovenous fistula stenosis

Indications for fistulography and correlation with detection of arteriovenous fistula stenosis.
Ismail I, Baer R, Mantha M, Neuen B, Granier F, Gunnarsson R.
Melbourne: Australian and New Zealand Society of Nephrology Annual Scientific Meeting; 2014.

Abstract

Aims:

To identify the indications for fistulograms and determine correlation between indication and radiological findings.

Background:

Dialysis access stenosis is the most common cause of access dysfunction. Clinical monitoring or vascular access surveillance abnormalities prompt a fistulogram. At our institution, fistulogram is primarily used to confirm stenosis.

Methods:

A retrospective observational study was conducted on 245 fistulograms performed at our institution over a two year period from January 2012 to December 2013. The indication for referral, fistulogram findings, type of fistula and demographic data were obtained.

Results:

Total of 75.5% (185 of 245) fistulograms performed confirmed stenosis. The most frequent clinical indication was high venous pressures – 18.4% (45 of 245) and the most common surveillance indication was abnormal access flow (Transonic®) – 17.1% (42 of 245). The average age was 57 years, with 35.9% Aboriginal and 28.2% Torres Straight Islander ethnicity. The most common type of vascular access was radiocephalic fistula (49.8%) followed by brachiocephalic fistula (43.3%). Further analysis of variables, using bivariate logistic regression analysis, failed to reveal any significant correlation between indications for referral and finding of stenosis. However, increased venous pressure tends to be associated with stenosis (Odds ratio 2.0, 95% CI = 0.84–4.7, P = 0.12). Both venous hypertension (Odds ratio 0.10, 95% CI = 0.011–1.0, P = 0.052) and development of collaterals (Odds ratio 0.077, 95% CI = 0.0084–0.70, P = 0.023) were associated with negative fistulograms.

Conclusions:

At our institution, the majority of fistulograms demonstrated access stenosis, based on established referral indications. Both venous hypertension and development of collaterals as referral indications were associated with less likelihood of finding vascular access stenosis in this cohort.


, from FoU-centrum för primärvård och folktandvård Södra Älvsborg
http://au.researchweb.org/is/en/foualvsborg/user/publication?ref=2013761