Assessment of Stenosis in Vascular Access Grafts

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Abstract

The major complication that occurs with grafts used as vascular access for hemodialysis, is stenosis at the venous anastomosis or in the draining vein. 75% area stenosis is considered significant as thrombotic occlusion may occur. The aim of this experimental study was to evaluate invasive and noninvasive indices to detect significant stenoses in a vascular access graft. A compliant underarm loop graft in vitro model was built and studied with 50, 65, 80, and 90% stenosis at flow rates of 500, 1000, and 1500 mL/min. Flow in the system was pulsatile. Velocity was measured with ultrasound Doppler and the pressure was measured invasively. The resistance index (RI), pvenous line/MAP, and the newly introduced pressure ratio (PR) were calculated and compared. A stenosis can be suspected when a high frequency ultrasound velocity signal develops at the venous anastomosis. RI > 1 confirms a very severe stenosis (90%). The parameter PR < 8% confirms significant stenoses showing its clinical relevancy.

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