Assessment of Occlusion of the Vascular Access in Patients on Chronic Hemodialysis: Comparison of Physical Examination with Continuous-Wave Doppler Ultrasound
Assessment of Occlusion of the Vascular Access in Patients on Chronic Hemodialysis: Comparison of Physical Examination with Continuous-Wave Doppler Ultrasound
复制标题
慢性血液透析患者血管通路闭塞的评估：体格检查与连续波多普勒超声的比较
作者：
R. Migliacci;M. L. Selli;Francesca Falcinelli;L. Vandelli;E. Lusvarghi;A. Santucci;G. Nenci;P. Gresele
背景资料：透析通路闭塞是长期血液透析患者住院的最常见原因，也是导致死亡的常见间接原因。动静脉分流的临床评估是目前诊断血液透析患者血管通路闭塞最广泛采用的方法，但尚未有研究客观地研究其敏感性和阳性预测值（PPV）。连续波（CW）多普勒超声是一种简单、廉价、无创的动脉血流评估技术。我们进行了一项前瞻性评估的PPV的CW多普勒诊断血管通路阻塞的血液透析患者，并与临床调查进行了比较。研究方法：对41例临床诊断为内瘘闭塞的血液透析患者进行了研究，其中23例患者的内瘘闭塞诊断得到了客观验证。结果如下：在客观证实闭塞的患者中，CW多普勒显示基础条件下和瘘管压迫后的PPV分别为86%和83%，灵敏度分别为95%和100%。在相同条件下，临床诊断显示PPV为83%，灵敏度为100%。结论：CW多普勒和临床检查对于诊断透析通路阻塞具有相似的高灵敏度;因此，除非需要客观记录，否则无需常规使用多普勒CW检查。
Background: Dialysis access occlusion is the most common cause of hospitalization and a frequent indirect cause of mortality in patients on chronic hemodialysis. The clinical assessment of an arteriovenous shunt is presently the most widely adopted method for the diagnosis of vascular access occlusion in hemodialysis patients, but no studies have yet investigated objectively its sensitivity and positive predictive value (PPV). Continuous-wave (CW) Doppler ultrasound is a simple, inexpensive, and noninvasive technique for the assessment of arterial blood flow. We have carried out a prospective evaluation of the PPV of CW Doppler for the diagnosis of vascular access occlusion in hemodialysis patients and compared it with clinical investigation. Methods: Fourty-one hemodialysis patients with clinical diagnosis of occlusion of their fistula were studied, and in 23 of them the diagnosis of occlusion was objectively validated. Results: CW Doppler in the patients in whom occlusion was objectively validated showed PPV of 86 and 83% under basal conditions and after fistula compression, respectively, with sensitivities of 95 and 100%, respectively. Clinical diagnosis, under the same conditions, showed a PPV of 83% and a sensitivity of 100%. Conclusions: CW Doppler and clinical examination have a similar high sensitivity for the diagnosis of occlusion of the dialysis access; thus, there is no need to use routinely Doppler CW examination, unless objective documentation is required.
永久血管通路：肾病专家的观点。
DOI：
10.1016/s0272-6386(12)80391-x
发表时间：
1993
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
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作者：
Windus,DW
通讯作者：
Windus,DW