Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands; Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Eur J Vasc Endovasc Surg. 2017 Nov;54(5):613-619. doi: 10.1016/j.ejvs.2017.08.005. Epub 2017 Sep 22.
Although clinical guidelines on arteriovenous fistula (AVF) creation advocate minimum luminal arterial and venous diameters, assessed by duplex ultrasonography (DUS), the clinical value of routine DUS examination is under debate. DUS might be an insufficiently repeatable and/or reproducible imaging modality because of its operator dependency. The present study aimed to assess intra- and inter-observer agreement of DUS examination in support of AVF surgery planning.
Ten end stage renal disease patients were included, to assess intra- and inter-observer agreement of pre-operative DUS measurements. All measurements were performed by two trained and experienced vascular technicians, blinded to measurement readings. From the routine DUS protocol, representative measurements (venous diameters, and arterial diameters and volume flow in the upper arm and forearm) were selected. For intra-observer agreement the measurements were performed in triplicate, with the probe released from the skin between each. Intraclass correlation coefficients were calculated for intra- and inter-observer agreement, and Bland-Altman plots used to graphically display mean measurement differences and limits of agreement.
Ten patients (6 male, 59.4±19.7 years) consented to participate, and all predefined measurements were obtained. Intraclass correlation coefficients for intra-observer agreement of diameter measurements were at least 0.90 (95% CI 0.74-0.97; radial artery). Inter-observer agreement was at least 0.83 (0.46-0.96; lateral diameter upper arm cephalic vein). The Bland-Altman plots showed acceptable mean measurement differences and limits of agreement.
In experienced hands, excellent intra- and inter-observer agreement can be reached for the discrete pre-operative DUS measurements advocated in clinical guidelines. DUS is therefore a reliable imaging modality to support AVF surgery planning. The content of DUS protocols, however, needs further standardisation.
尽管动静脉瘘（AVF）创建的临床指南主张通过双功能超声（DUS）评估最小管腔动脉和静脉直径，但常规 DUS 检查的临床价值仍存在争议。由于其对操作人员的依赖性，DUS 可能是一种重复性和/或可再现性不足的成像方式。本研究旨在评估 DUS 检查的观察者内和观察者间一致性，以支持 AVF 手术计划。
纳入 10 名终末期肾病患者，评估术前 DUS 测量的观察者内和观察者间一致性。所有测量均由两名经过培训且经验丰富的血管技术人员进行，他们对测量读数一无所知。从常规 DUS 方案中，选择具有代表性的测量值（静脉直径以及上臂和前臂的动脉直径和体积流量）。对于观察者内一致性，测量值进行了三次重复测量，每次测量之间将探头从皮肤中释放。计算了观察者内和观察者间一致性的组内相关系数，并使用 Bland-Altman 图直观显示平均测量差异和一致性界限。
10 名患者（6 名男性，59.4±19.7 岁）同意参与，并且获得了所有预设的测量值。直径测量的观察者内一致性的组内相关系数至少为 0.90（95%CI 0.74-0.97；桡动脉）。观察者间一致性至少为 0.83（0.46-0.96；上臂外侧头静脉）。Bland-Altman 图显示出可接受的平均测量差异和一致性界限。
在经验丰富的手中，临床指南中提倡的离散术前 DUS 测量可以达到出色的观察者内和观察者间一致性。因此，DUS 是一种支持 AVF 手术计划的可靠成像方式。然而，DUS 协议的内容需要进一步标准化。
