Original Paper

Detection of Vascular Access Stenosis by Measurement of Access Blood Flow from Ionic Dialysance
Lucile Mercadal^a, Emmanuel Challier^b, Philippe Cluzel^b, Abdelaziz Hamani^a, Hacène Boulechfar^a, Zhora Boukhalfa^a, Hassane Izzedine^a, Nader Bassilios^a, Benoît Barrou^c, Gilbert Deray^a, Thierry Petitclerc^a

Departments of a
^aNephrology,
^bRadiology, and
^cUrology, Pitié-Salpêtrière Hospital, Paris, France

Address of Corresponding Author

Blood Purif 2002;20:177-181 (DOI: 10.1159/000047006)

  Key Words

• Hemodialysis
• Vascular access
• Access blood flow rate
• Ultrasonography

  Abstract

Background/Aim: The measurement of the vascular access blood flow rate (Q_a) in chronic hemodialyzed patients was proposed to predict access thrombosis. We have recently presented a new method based on the measurements of ionic dialysance at normal and reversed positions of the blood lines. We evaluate the reliability of the measurement of Q_a by this method in detecting significant access stenoses. Methods: Twenty-five patients on chronic hemodialysis and having a vascular access cannulated with two needles were studied. The Q_a was evaluated by the Diascan^® ionic dialysance (Q_a-id) method and by the ultrasound dilution technique (Q_a-us; Transonic^®) during the same dialysis session. The measurements were available for 23 patients. In addition, the patients had ultrasonography of their fistula followed by angiography, if a stenosis was detected. Results: Q_a-id and Q_a-us were not significantly different, showing a difference in Q_a at 32 ± 469 ml/min. Q_a-id was significantly different between patients with or without stenosis (508 ± 241 vs. 1,125 ± 652 ml/min, p < 0.05). Among patients with a Q_a <500 ml/min by Q_a-id, 5 had a stenosis detected by ultrasonography (sensitivity 83%), and 3 had no stenosis (false-positive rate 18%). Of these 3 patients, 2 had a thrombotic event at 1 and 3 months, suggesting that a more sensitive detection of stenosis for this range of Q_a is needed and that a Q_a <500 ml/min has a higher power to predict thromboses than a stenosis by ultrasonography. Conclusions: The measurement of the access flow rate by the Q_a-id method has a clinical relevance to the detection of vascular access stenosis. An intervention program based on the Q_a-id has to be evaluated.

Copyright © 2002 S. Karger AG, Basel

  Author Contacts

L. Mercadal
Department of Nephrology, Pitié-Salpêtrière Hospital
83, boulevard de l’Hôpital
F–75013 Paris (France)
Tel. +33 142177220, Fax +33 142177914, E-Mail lucile.mercadal@psl.ap-hop-paris.fr

  Article Information

Accepted: July 10, 2001
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 2, Number of References : 21