Physical Examination Of Arteriovenous Fistula: A Basic Approach In AV Fistula Stenosis Detection

Abstract

Objectives: To determine the accuracy and equivalence of physical examination, MDCTA and Doppler ultrasound in detection of arteriovenous fistula (AVF) stenosis. Materials and Methods: We conducted a pilot study in hemodialysis department of PNS Shifa withprospective diagnostic cohort design on 15 patients, referred for evaluation of arteriovenous fistuladysfunction. Physical examination of arteriovenous fistula was done followed by Doppler ultrasound and MDCTangiography.The results of each patient was recorded and sealed. Data analyzed byCohen's Kappa, which determined the level of agreement between the diagnosis made by Physical examination, MDCTangiography and Doppler ultrasound. Results: There was significant agreement in AVF stenosis detection made by physical examination and MDCTangiography (K: 0.865 for inflow stenosis and K: 0.602 for outflow stenosis).Whereas moderate level of agreement was observed between physical examination and Doppler ultrasound (K: 0.471 for inflow stenosis, K: 0.444 for outflow stenosis). Fair agreement existed between MDCTA and Doppler ultrasound in outflow stenosis detection. Conclusion: Physical examination is accurate and equivalent in AVF stenosis detection when compared with MDCTangiography and superior in stenosis detection when compared with Doppler ultrasound in our hospital. Doppler Ultrasound is inferior to MDCTA in diagnosis of outflow stenosis.