Value of duplex Doppler ultrasonography for the evaluation of dysfunctional hemodialysis access arteriovenous fistulas prior to endovascular interventions

PURPOSE: To demonstrate accuracy of duplex Doppler ultrasonography (DUS) for the evaluation of native-vein arteriovenous fistula (AVF) dysfunction in end-stage renal disease patients. METHODS: This retrospective study included 60 patients with dysfunctioning native-vein AVF evaluated with DUS and digital subtraction angiography (DSA) whose results were compared for detection, identification, and localization of AVF lesions. We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DUS and evaluated the agreement between DUS and DSA by the Cohen's kappa coefficient (κ). RESULTS: DUS identified correctly 123 of 130 lesions (sensitivity 94.6%, specificity 97.5%, PPV 98.4%, NPV 92%, accuracy of 95.7%). DUS localized correctly 123 of 130 lesions (sensitivity 94.6%, specificity 98.4%, PPV 98.4%, NPV 94.6%, accuracy 96.4%). The κ value was 0.9120 for detection of all lesions (almost perfect agreement). CONCLUSION: DUS is a reliable method for the initial evaluation of dysfunctional AVFs, with high sensitivity for detecting and correctly localizing circuit problems.