Jawas Ali, Murtuza Mohammad, Abu-Zidan Fikri M
Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE.
Department of Radiology, Tawam Hospital, Al-Ain, UAE.
Int Urol Nephrol. 2025 Jun 1. doi: 10.1007/s11255-025-04588-x.
This study evaluated the diagnostic accuracy of duplex ultrasound (DUS) using peak systolic velocity (PSV), PSV ratio (PSVR), and volume flow in detecting vascular access stenosis, compared to digital subtraction angiography.
A cohort of 121 patients with arteriovenous (AV) fistulas or grafts were evaluated between January 2013 and September 2013 for clinical indicators of dysfunction, including reduced thrill, weak bruit, decreased dialysis flow, high venous pressure or excessive post-dialysis bleeding using our own collective diagnostic criteria based on previously published parameters. Critical stenosis was defined as PSV >400 cm/s, PSVR >3.5, and volume flow <400 mL/min. Angiography was performed for all hemodynamically significant stenoses diagnosed by DUS.
Among 121 patients (mean age, 56.6 ± 17.3 years; 64% men), DUS findings included normal studies (24%), mild stenosis (9.9%), moderate stenosis (15.7%), severe stenosis (40.5%), and total occlusions (9.9%). Stenosis locations were at the anastomotic site (86.3%), the junctional (11.3%), and the venous outflow (2.5%). Critical stenosis was identified in 49 (40.5%) patients. Of 46 patients who underwent angiography, critical stenosis was confirmed in 44. DUS demonstrated a positive predictive value (PPV) of 95.6% for detecting significant stenosis, supporting its reliability in vascular access assessment. Study limitations include its small sample size, retrospective design, and limited generalizability. Furthermore, analysis was limited to positive sonographic findings precluding sensitivity/specificity assessment.
DUS is accurate in diagnosing severe vascular access stenosis, with a PPV exceeding 95%. Its non-invasive nature and high predictive value support its use as a first-line imaging modality for vascular access evaluation.
本研究将双功超声（DUS）利用收缩期峰值流速（PSV）、PSV比值（PSVR）和血流量检测血管通路狭窄的诊断准确性与数字减影血管造影进行了比较。
2013年1月至2013年9月期间，对121例动静脉（AV）内瘘或移植物患者进行了评估，以确定功能障碍的临床指标，包括震颤减弱、杂音减弱、透析血流量减少、静脉压升高或透析后出血过多，采用我们基于先前发表参数制定的综合诊断标准。临界狭窄定义为PSV>400 cm/s、PSVR>3.5且血流量<400 mL/min。对所有经DUS诊断为具有血流动力学意义的狭窄进行血管造影。
121例患者（平均年龄56.6±17.3岁；64%为男性）中，DUS检查结果包括正常（24%）、轻度狭窄（9.9%）、中度狭窄（15.7%）、重度狭窄（40.5%）和完全闭塞（9.9%）。狭窄部位位于吻合口处（86.3%）、连接处（11.3%）和静脉流出道（2.5%）。49例（40.5%）患者被确定为临界狭窄。在46例行血管造影的患者中，44例被证实为临界狭窄。DUS检测显著狭窄的阳性预测值（PPV）为95.6%，支持其在血管通路评估中的可靠性。研究局限性包括样本量小、回顾性设计和有限的可推广性。此外，分析仅限于超声检查阳性结果，排除了敏感性/特异性评估。
DUS在诊断严重血管通路狭窄方面准确，PPV超过95%。其无创性和高预测价值支持将其用作血管通路评估的一线成像方式。
