Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas
Abstract Background Pulsatility is an important property of hemodialysis arteriovenous fistulas (AVF) and can be perceived by the fingers as a gradual decrease in strength downstream from the anastomosis along the main trunk of the fistula. The distance from the point at which the pulse becomes impe...
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doaj-682d580f72f54d70bdd169116208e53f2020-11-25T03:14:14ZengBMCBMC Nephrology1471-23692019-09-012011910.1186/s12882-019-1536-2Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulasMatt Chiung-Yu Chen0Mei-Jui Weng1Misoso Yi-Wen Wu2Yi-Chun Liu3Wen-Che Chi4Department of Interventional Radiology, Yuan’s General HospitalDepartment of Radiology, Kaohsiung Veterans General HospitalDepartment of Interventional Nursing, Yuan’s General HospitalDepartment of Nephrology, Yuan’s General HospitalDepartment of Nephrology, Yuan’s General HospitalAbstract Background Pulsatility is an important property of hemodialysis arteriovenous fistulas (AVF) and can be perceived by the fingers as a gradual decrease in strength downstream from the anastomosis along the main trunk of the fistula. The distance from the point at which the pulse becomes imperceptible to the anastomosis is termed the palpable pulsatility length (PPL); we considered this length may play a role in assessing the severity of inflow stenosis for hemodialysis fistulas. Methods This study was performed by retrospective analysis of routinely collected data. Physical examinations and fistula measurements were performed in a selected population of 76 hemodialysis patients with mature fistulas during half a year. Fistula measurements included the PPL before and after treatment and the distance between the anastomosis and the arterial cannulation site (aPump length). The aPump index (API) was calculated by dividing the PPL by the aPump length. Angiograms were reviewed to determine the location and severity of stenosis. PPL and API were used to detect the critical inflow stenosis, which indicates severe inflow stenosis of an AVF. Results Receiver operating characteristic analysis showed that the area under the curve was 0.895 for API and 0.878 for PPL. A cutoff value of API < 1.29 and PPL < 11.0 cm were selected to detect the critical inflow stenosis. The sensitivity was 96.0% versus 80.0% and specificity was 84.31% versus 84.31% for API and PPL, respectively. Conclusions PPL and API are useful tools in defining the severity of pure inflow stenosis for mature AVFs in the hands of trained examiners with high sensitivity and specificity.http://link.springer.com/article/10.1186/s12882-019-1536-2HemodialysisPhysical examinations and diagnosesArteriovenous shuntSurgicalBlood flow velocity |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Matt Chiung-Yu Chen Mei-Jui Weng Misoso Yi-Wen Wu Yi-Chun Liu Wen-Che Chi |
spellingShingle |
Matt Chiung-Yu Chen Mei-Jui Weng Misoso Yi-Wen Wu Yi-Chun Liu Wen-Che Chi Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas BMC Nephrology Hemodialysis Physical examinations and diagnoses Arteriovenous shunt Surgical Blood flow velocity |
author_facet |
Matt Chiung-Yu Chen Mei-Jui Weng Misoso Yi-Wen Wu Yi-Chun Liu Wen-Che Chi |
author_sort |
Matt Chiung-Yu Chen |
title |
Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas |
title_short |
Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas |
title_full |
Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas |
title_fullStr |
Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas |
title_full_unstemmed |
Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas |
title_sort |
measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas |
publisher |
BMC |
series |
BMC Nephrology |
issn |
1471-2369 |
publishDate |
2019-09-01 |
description |
Abstract Background Pulsatility is an important property of hemodialysis arteriovenous fistulas (AVF) and can be perceived by the fingers as a gradual decrease in strength downstream from the anastomosis along the main trunk of the fistula. The distance from the point at which the pulse becomes imperceptible to the anastomosis is termed the palpable pulsatility length (PPL); we considered this length may play a role in assessing the severity of inflow stenosis for hemodialysis fistulas. Methods This study was performed by retrospective analysis of routinely collected data. Physical examinations and fistula measurements were performed in a selected population of 76 hemodialysis patients with mature fistulas during half a year. Fistula measurements included the PPL before and after treatment and the distance between the anastomosis and the arterial cannulation site (aPump length). The aPump index (API) was calculated by dividing the PPL by the aPump length. Angiograms were reviewed to determine the location and severity of stenosis. PPL and API were used to detect the critical inflow stenosis, which indicates severe inflow stenosis of an AVF. Results Receiver operating characteristic analysis showed that the area under the curve was 0.895 for API and 0.878 for PPL. A cutoff value of API < 1.29 and PPL < 11.0 cm were selected to detect the critical inflow stenosis. The sensitivity was 96.0% versus 80.0% and specificity was 84.31% versus 84.31% for API and PPL, respectively. Conclusions PPL and API are useful tools in defining the severity of pure inflow stenosis for mature AVFs in the hands of trained examiners with high sensitivity and specificity. |
topic |
Hemodialysis Physical examinations and diagnoses Arteriovenous shunt Surgical Blood flow velocity |
url |
http://link.springer.com/article/10.1186/s12882-019-1536-2 |
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