Abstract: TH-OR139
Ferumoxytol MR Angiography vs. Doppler Ultrasound for Vascular Mapping Before Hemodialysis Arteriovenous Fistula Creation
Session Information
- Vascular Access and Complications of Hemodialysis
November 07, 2019 | Location: 201, Walter E. Washington Convention Center
Abstract Time: 04:42 PM - 04:54 PM
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 –