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Abstract: FR-PO465

Contrast Venography vs. Intravenous Ultrasound in Arteriovenous Access Dysfunction

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Idrees, Najia, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
  • Haroon, Samir, Boston Medical Center, Boston, Massachusetts, United States
  • Zhang, Yichi, Boston Medical Center, Boston, Massachusetts, United States
  • Mangio, Joanna Crisa, Boston Medical Center, Boston, Massachusetts, United States
  • Cabral, Howard J., Boston Medical Center, Boston, Massachusetts, United States
  • Dember, Laura M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Chitalia, Vipul C., Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
Background

Contrast venography, a standard approach for evaluating hemodialysis vascular access dysfunction, has several limitations that may be overcome by intravascular ultrasound (IVUS).

Methods

Venography and IVUS were performed in a prospective study of 41 patients with arteriovenous access dysfunction. Radiologists estimated stenosis on venograms and annotated cross-sectional IVUS images (N=250) that were used to train a deep neural network to analyze a
larger set of IVUS images (N=27,315). Two measures were extracted from the IVUS images –eccentricity and homogeneity indices – characterizing stenosis shape and wall texture, respectively.

Results

Among the 33 patients with high quality images, 20 had a single stenosis and 13 had two stenoses of any severity (total of 46 stenoses). Twenty-four stenoses with >50% lumen reduction were detected by both venography and IVUS, and 14 additional stenoses were detected by IVUS but not by venography. A discordance between the two modalities was observed (McNemar ratio 7.11, p=0.0076; kappa 0.163). The severity of stenosis (%) was lower by venography (mean+SD 51.7+14.1) compared to IVUS (64.9+18.1, p=0.002). IVUS image
analysis showed higher eccentricity and homogeneity indices for stenotic lesions compared to the reference segments. Metrics comparing stenoses and reference segments demonstrated substantial variability in the distribution of both indices.

Conclusion

Compared to IVUS, venography underestimated severity of stenoses in ~30% of patients presenting with arteriovenous access dysfunction. Further studies are needed to confirm the superiority of IVUS over venography and to establish the clinical utility of morphological indices for predicting stenosis progression and response to intervention.

Frequency distribution of stenoses severity detected by both modalities
Frequency of stenosis by venogramFrequency of stenosis by IVUSTotal
 <50%>50% 
<50%51419
>50%32427
Total83846

Disagreement between venogram and IVUS