ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR139

Ferumoxytol MR Angiography vs. Doppler Ultrasound for Vascular Mapping Before Hemodialysis Arteriovenous Fistula Creation

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Stoumpos, Sokratis, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Tan, Alfred B., University Hospital Hairmyres, Glasgow, United Kingdom
  • Roditi, Giles, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Mark, Patrick B., University of Glasgow, Glasgow, United Kingdom
Background

Doppler ultrasound (DUS) is routinely performed for vascular mapping prior to placement of a hemodialysis arteriovenous fistula (AVF) but can not adequately visualize the central vasculature. Ferumoxytol, an iron oxide nanoparticle, is an alternative to gadolinium for magnetic resonance angiography (MRA). We compared ferumoxytol-enhanced MRA (FeMRA) with DUS for assessment of the central and upper extremity vasculature in patients with renal disease due for autologous AVF creation.

Methods

In a prospective comparative study, paired FeMRA and DUS were obtained on the same day. Three readers independently assessed arterial and vein diameter and the presence of stenosis or occlusion (central or peripheral) with FeMRA and US. Interclass correlation coefficients (ICC) and Bland-Altman plots examined inter-reader variability. Based on accepted standards for the creation of an AVF, an algorithm was created to predict AVF outcome relying on mapping findings. Two binomial logistic regression models were created with AVF outcome as the dependent variable and age, sex, and US prediction algorithm (model 1) or FeMRA prediction algorithm (model 2) as the predictor variables.

Results

From the 59 patients that had FeMRA and DUS, 51 had an autologous AVF created. FeMRA showed excellent inter-reader repeatability (ICC 0.84-0.99). Vessel course, accessory veins, anatomical variants and the presence of stenosis or occlusion in arm vessels were better assessed with FeMRA. FeMRA identified 15 central vasculature stenoses (CVS). On multivariable regression analyses FeMRA mapping was an independent predictor of AVF outcome [odds ratio (OR): 6.49 (95% CI 1.7 - 24.8); p=0.02].

Conclusion

FeMRA prior to AVF creation better predicted outcome compared to DUS. Its value is not limited in identification of central vessels pathology but it also showed peripheral vascular disease under-recognized with US.

Representative images of CVS with FeMRA.

Funding

  • Commercial Support