Abstract
Background and objectives: Physical examination has been highlighted to detect vascular access stenosis; however, its accuracy in the identification of stenoses when compared with the gold standard (angiography) has not been validated in a systematic manner. Design, setting, participants, & measurements: A prospective study was conducted of 142 consecutive patients who were referred for an arteriovenous fistula dysfunction to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. The findings of a preprocedure physical examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was then performed. The images were reviewed by an independent interventionalist who had expertise in endovascular dialysis access procedures and was blinded to the physical examination, and the diagnosis was rendered. Cohen's κ was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. Results: There was strong agreement between physical examination and angiography in the diagnosis of outflow (agreement 89.4%, κ = 0.78) and inflow stenosis (agreement 79.6%, κ = 0.55). The sensitivity and specificity for the outflow and inflow stenosis were 92 and 86% and 85 and 71%, respectively. There was strong agreement beyond chance regarding the diagnosis of coexisting inflow-outflow lesions between physical examination and angiography (agreement 79%, κ = 0.54). Conclusions: The findings of this study demonstrate that physical examination can accurately detect and localize stenoses in a great ajority of arteriovenous fistulas.
| Original language | English |
|---|---|
| Pages (from-to) | 1191-1194 |
| Number of pages | 4 |
| Journal | Clinical Journal of the American Society of Nephrology |
| Volume | 2 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 1 2007 |
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ASJC Scopus subject areas
- Nephrology
- Transplantation
- Epidemiology
- Critical Care and Intensive Care Medicine
- Medicine(all)
Cite this
Accuracy of physical examination in the detection of arteriovenous fistula stenosis. / Asif, Arif; Leon, Carlos; Orozco-Vargas, Luis Carlos; Krishnamurthy, Gururaj; Choi, Kenneth L.; Mercado, Carlos; Merrill, Donna; Thomas, Ian; Salman, Loay; Artikov, Shukhrat; Bourgoignie, Jacques J.
In: Clinical Journal of the American Society of Nephrology, Vol. 2, No. 6, 01.11.2007, p. 1191-1194.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Accuracy of physical examination in the detection of arteriovenous fistula stenosis
AU - Asif, Arif
AU - Leon, Carlos
AU - Orozco-Vargas, Luis Carlos
AU - Krishnamurthy, Gururaj
AU - Choi, Kenneth L.
AU - Mercado, Carlos
AU - Merrill, Donna
AU - Thomas, Ian
AU - Salman, Loay
AU - Artikov, Shukhrat
AU - Bourgoignie, Jacques J.
PY - 2007/11/1
Y1 - 2007/11/1
N2 - Background and objectives: Physical examination has been highlighted to detect vascular access stenosis; however, its accuracy in the identification of stenoses when compared with the gold standard (angiography) has not been validated in a systematic manner. Design, setting, participants, & measurements: A prospective study was conducted of 142 consecutive patients who were referred for an arteriovenous fistula dysfunction to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. The findings of a preprocedure physical examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was then performed. The images were reviewed by an independent interventionalist who had expertise in endovascular dialysis access procedures and was blinded to the physical examination, and the diagnosis was rendered. Cohen's κ was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. Results: There was strong agreement between physical examination and angiography in the diagnosis of outflow (agreement 89.4%, κ = 0.78) and inflow stenosis (agreement 79.6%, κ = 0.55). The sensitivity and specificity for the outflow and inflow stenosis were 92 and 86% and 85 and 71%, respectively. There was strong agreement beyond chance regarding the diagnosis of coexisting inflow-outflow lesions between physical examination and angiography (agreement 79%, κ = 0.54). Conclusions: The findings of this study demonstrate that physical examination can accurately detect and localize stenoses in a great ajority of arteriovenous fistulas.
AB - Background and objectives: Physical examination has been highlighted to detect vascular access stenosis; however, its accuracy in the identification of stenoses when compared with the gold standard (angiography) has not been validated in a systematic manner. Design, setting, participants, & measurements: A prospective study was conducted of 142 consecutive patients who were referred for an arteriovenous fistula dysfunction to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. The findings of a preprocedure physical examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was then performed. The images were reviewed by an independent interventionalist who had expertise in endovascular dialysis access procedures and was blinded to the physical examination, and the diagnosis was rendered. Cohen's κ was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. Results: There was strong agreement between physical examination and angiography in the diagnosis of outflow (agreement 89.4%, κ = 0.78) and inflow stenosis (agreement 79.6%, κ = 0.55). The sensitivity and specificity for the outflow and inflow stenosis were 92 and 86% and 85 and 71%, respectively. There was strong agreement beyond chance regarding the diagnosis of coexisting inflow-outflow lesions between physical examination and angiography (agreement 79%, κ = 0.54). Conclusions: The findings of this study demonstrate that physical examination can accurately detect and localize stenoses in a great ajority of arteriovenous fistulas.
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UR - http://www.scopus.com/inward/citedby.url?scp=38449102500&partnerID=8YFLogxK
U2 - 10.2215/CJN.02400607
DO - 10.2215/CJN.02400607
M3 - Article
C2 - 17928468
AN - SCOPUS:38449102500
VL - 2
SP - 1191
EP - 1194
JO - Clinical journal of the American Society of Nephrology : CJASN
JF - Clinical journal of the American Society of Nephrology : CJASN
SN - 1555-9041
IS - 6
ER -