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Monitoring and Surveillance of Hemodialysis Vascular Access Using StenTec and Physical Exam
Author(s) -
Dhamija Rajiv,
Nash Shawn K.,
Nguyen Shawn V.,
Slack Kyle,
Tadeo Joseph
Publication year - 2014
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12311
Subject(s) - medicine , hemodialysis , stenosis , cardiology , gold standard (test) , physical examination , population , blood pressure , radiology , surgery , environmental health
Hemodialysis vascular access surveillance for hemodynamically significant stenosis can be a challenge because no universal gold standard exists. The StenTec Gauge measures static intra‐access peak pressure and graphically displays the ratio of this pressure to systemic systolic (peak) arterial pressure ( P IA ratio). In combination with careful physical exam ( PE ), the StenTec Gauge is an acceptable and cost‐effective way of detecting hemodynamically significant stenosis in arteriovenous fistulas ( AVF ) or grafts ( AVG ). In a selected population of 21 hemodialysis patients with mature arteriovenous access, a StenTec reading and physical examination was measured on a weekly basis. Interventional procedures for suspected access dysfunction were performed if there was a greater than 25% increase of the P IA ratio from baseline in two consecutive readings, along with correlating clinical suspicion from physical examination findings. StenTec independently had a sensitivity of 56% and a specificity of 99% in detecting clinically significant stenosis. PE alone had a sensitivity of 89% and a specificity of 100%. StenTec combined with PE had a sensitivity of 100% and a specificity of 99% for predicting hemodynamically significant stenosis. StenTec detected 4 of 10 patients who had a P IA ratio value of ≥0.5, which correlates with current National Kidney Foundation Disease Outcomes Quality Initiative ( KDOQI ) criteria for mean intra‐access pressure ratios indicating a clinically significant outflow stenosis. PE predicted 9 of 10 patients with stenosis, and the combination of StenTec and PE predicted all 10 patients with clinically significant stenosis using the KDOQI criteria for P IA ratio. Hemodynamically significant access stenosis can be detected with excellent accuracy using both StenTec and PE measurements combined for monitoring and surveillance methods.