Bilateral peripheral CT venography for evaluating central venous lesions in dysfunctional arteriovenous fistulas: feasibility, safety, and radiation dose in hemodialysis patients

OBJECTIVES: Central venous stenosis and occlusion are major causes of arteriovenous fistula (AVF) dysfunction in hemodialysis patients. This study aimed to evaluate the feasibility, safety, radiation exposure, and anatomical findings of bilateral peripheral CT venography for central venous assessment in patients with dysfunctional AVFs. METHODS: This single-center retrospective cohort study included 46 consecutive hemodialysis patients with dysfunctional AVFs who underwent bilateral peripheral CT venography between August 2023 and June 2025. Technical success, procedure-related adverse events, radiation dose parameters, central venous lesion characteristics, and agreement with available comparative imaging modalities were analyzed. Comparative imaging findings from puncture-based angiography and/or duplex ultrasonography were assessed descriptively. RESULTS: All 46 examinations were technically successful (100%), with a mean procedure duration of 4 minutes (range, 3-5 minutes). Minor adverse events included one patient of contrast extravasation (2.2%) and 3 of mild allergic reactions (6.5%); no severe procedure-related complications were documented. The mean CTDIvol and DLP were 11.87 mGy and 784.15 mGy·cm, respectively. Central venous abnormalities were identified in 44 patients (95.7%), including stenosis in 31 (67.4%), occlusion in 11 (23.9%), and aneurysmal changes in 2 (4.3%). Comparative imaging was available in 38 patients, and CT venography showed agreement with available findings in 37 cases (97.4%). This agreement was interpreted as descriptive concordance rather than formal diagnostic accuracy. CONCLUSIONS: Bilateral peripheral CT venography demonstrated high technical feasibility, acceptable safety, and effective visualization of central venous abnormalities in hemodialysis patients with dysfunctional AVFs. Further prospective studies are needed to validate its diagnostic performance and clinical impact. ADVANCES IN KNOWLEDGE: This technique enables efficient, noninvasive assessment of central venous pathology with minimal risk, supporting its potential as a practical alternative to conventional imaging in hemodialysis patients.