Key result
Physical examination demonstrated an accuracy of 88% (sensitivity 96%, specificity 76%) for detecting arteriovenous fistula stenosis, compared to 71% accuracy for intra-access pressure.
Why the study?
Does physical examination or intra-access pressure accurately detect stenosis in hemodialysis arteriovenous fistulas compared to Doppler ultrasound?
Observational (n=84)
Does physical examination or intra-access pressure accurately detect stenosis in hemodialysis arteriovenous fistulas compared to Doppler ultrasound?
Absolute Event Rate: 88% vs 71%
Physical examination is a highly accurate method for diagnosing arteriovenous fistula stenosis and should be routinely included in surveillance protocols.
Supports physical examination over intra-access pressure for AVF stenosis detection; leaves open prospective validation versus Doppler.
Both physical examination (PE) and intra-access pressure (IAP) measurements have been used in the identification of stenosis in an arteriovenous access. The aim of this study was to evaluate the accuracy of PE and IAP in the diagnosis of arteriovenous fistula (AVF) stenosis. A total of 84 patients were enrolled in the study (54% men, mean age of 50.7 +/- 12.7 years and mean AVF patency of 24.9 +/- 7.8 months, 52% radiocephalic). Abnormalities of pulse and thrill were used as the diagnostic tools for the detection of stenosis using the physical examination. For IAP, stenosis was suspected when the ratio between IAP at the arterial puncture site and the mean blood pressure was <0.13 or >0.43. The diagnosis of stenosis was confirmed by Doppler ultrasound (DU). Sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (PNV), and accuracy were calculated for the two early detection tests. According to DU, 50 (59%) AVF were considered positive for the presence of stenosis. Fifty-six (66%) AVF were considered positive for the presence of stenosis by PE and 34 (40%) by IAP. S, SP, PPV, and NPV for PE and IAP were 96%, 76%, 86%, and 93% and 60%, 88%, 88%, and 60%, respectively. The accuracy for PE and IAP was 88% and 71%, respectively. PE proved to be an accurate method for the diagnosis of stenosis and should be part of all surveillance protocols of stenosis detection in AVF.
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Campos et al. (2008) conducted an observational in Hemodialysis Arteriovenous Fistula stenosis (n=84). Physical examination (PE) vs. Intra-access pressure (IAP) was evaluated on Accuracy in the diagnosis of arteriovenous fistula (AVF) stenosis. Physical examination demonstrated an accuracy of 88% (sensitivity 96%, specificity 76%) for detecting arteriovenous fistula stenosis, compared to 71% accuracy for intra-access pressure.
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