Accuracy of physical examination in the detection of arteriovenous graft stenosis

Carlos Leon, Luis Carlos Orozco-Vargas, Gururaj Krishnamurthy, Kenneth L. Choi, Carlos Mercado, Donna Merrill, Ian Thomas, Loay Salman, Shukhrat Artikov, Jacques J. Bourgoignie, Arif Asif

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Physical examination has recently been demonstrated to detect vascular access stenosis in patients with arteriovenous fistulae. However, its accuracy in the identification of stenoses when compared with the gold standard (angiography) in patients with arteriovenous grafts has not been studied in a systematic fashion. We conducted a prospective study to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. Forty-three consecutive cases referred for an arteriovenous graft dysfunction were included in this analysis. Preprocedure physical examination was performed. The findings of the examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was performed. The images were reviewed by an independent interventionalist with expertise in endovascular dialysis access procedures and the diagnosis was rendered. The reviewer was blinded to the physical examination. Cohen's Kappa was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. There was a strong agreement between the physical examination and the angiography in the diagnosis of vein-graft anastomotic stenosis (kappa = 0.52). The sensitivity and specificity for this lesion was 57% and 89%, respectively. There was a moderate agreement beyond chance regarding the diagnosis of intragraft (kappa = 0.43) and inflow stenoses (kappa = 0.40). The sensitivity and specificity for the intragraft and inflow stenosis was 100%, 73% and 33%, 73%; respectively. The findings of this study demonstrate that physical examination can assist in the detection and localization of stenoses in arteriovenous grafts.

Original languageEnglish
Pages (from-to)85-88
Number of pages4
JournalSeminars in Dialysis
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2008

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Physical Examination
Pathologic Constriction
Transplants
Angiography
Sensitivity and Specificity
Arteriovenous Fistula
Heart Atria
Blood Vessels
Dialysis
Veins
Arteries
Prospective Studies

ASJC Scopus subject areas

  • Nephrology

Cite this

Leon, C., Orozco-Vargas, L. C., Krishnamurthy, G., Choi, K. L., Mercado, C., Merrill, D., ... Asif, A. (2008). Accuracy of physical examination in the detection of arteriovenous graft stenosis. Seminars in Dialysis, 21(1), 85-88. https://doi.org/10.1111/j.1525-139X.2007.00382.x

Accuracy of physical examination in the detection of arteriovenous graft stenosis. / Leon, Carlos; Orozco-Vargas, Luis Carlos; Krishnamurthy, Gururaj; Choi, Kenneth L.; Mercado, Carlos; Merrill, Donna; Thomas, Ian; Salman, Loay; Artikov, Shukhrat; Bourgoignie, Jacques J.; Asif, Arif.

In: Seminars in Dialysis, Vol. 21, No. 1, 01.01.2008, p. 85-88.

Research output: Contribution to journalArticle

Leon, C, Orozco-Vargas, LC, Krishnamurthy, G, Choi, KL, Mercado, C, Merrill, D, Thomas, I, Salman, L, Artikov, S, Bourgoignie, JJ & Asif, A 2008, 'Accuracy of physical examination in the detection of arteriovenous graft stenosis', Seminars in Dialysis, vol. 21, no. 1, pp. 85-88. https://doi.org/10.1111/j.1525-139X.2007.00382.x
Leon C, Orozco-Vargas LC, Krishnamurthy G, Choi KL, Mercado C, Merrill D et al. Accuracy of physical examination in the detection of arteriovenous graft stenosis. Seminars in Dialysis. 2008 Jan 1;21(1):85-88. https://doi.org/10.1111/j.1525-139X.2007.00382.x
Leon, Carlos ; Orozco-Vargas, Luis Carlos ; Krishnamurthy, Gururaj ; Choi, Kenneth L. ; Mercado, Carlos ; Merrill, Donna ; Thomas, Ian ; Salman, Loay ; Artikov, Shukhrat ; Bourgoignie, Jacques J. ; Asif, Arif. / Accuracy of physical examination in the detection of arteriovenous graft stenosis. In: Seminars in Dialysis. 2008 ; Vol. 21, No. 1. pp. 85-88.
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