It is known that when the minimal luminal diameter (MLD) of stenosis decreases, the risk of high-shear- related thrombosis is increased. Currently, MLD is measured using sonography or angiography.
This was a retrospective case-control study using routinely collected data. To assess the severity of AVF inflow and outflow stenosis, the study used post-stenosis palpable pulsatility length (sPPL) and pulse-and-thrill based outflow score, respectively. Paired quantitative PE indicators and MLD before and after angioplasty were recorded in patients enrolled over a 4-month period.
From 163 patients, a total of 249 paired PE indicators and MLD measurements were obtained. An MLD cutoff value of <1.55 mm and an MLD of <1.95 mm discriminated sPPL = 0 and PESOS (physical examination significant outflow stenosis)/1- of the outflow score, respectively, from all other measurements, with the area under the curve values of 0.8922 and 0.9618, respectively were demonstrated in a receiver operating characteristic curve analysis. With sPPL = 0 and PESOS/1- of the outflow score as diagnostic tools to detect inflow stenosis with an MLD of ≤1.5 mm and outflow stenosis with an MLD of ≤1.9 mm at vascular access sites, sensitivity = 86.00% and 88.46%; specificity = 97.67% and 92.11%; positive predictive values of 97.73% and 92.00% and negative predictive values of 85.71% and 88.61%, respectively, were reported.
In detecting patients with stenosis who are at a high risk for thrombosis at hemodialysis vascular access sites, physical examination can potentially be a diagnostic tool with high diagnostic accuracy.