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MDCT Angiography for Evaluation of the Complete Vascular Tree of Hemodialysis Fistulas

Sheung-Fat Ko1, Chung-Cheng Huang1, Shu-Hang Ng1, Tze-Yu Lee1, Ming-Jang Hsieh2, Fan-Yen Lee2, Min-Chi Chen3, Shyr-Ming Sheen-Chen4 and Chi-Hsiung Lee5

1 Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, 123 Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
2 Department of Thoracic and Vascular Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
3 Department of Public Health and Biostatistics, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
4 Department of General Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
5 Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.



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  		Fig. 1A —56-year-old woman with insufficient flow of brachiobasilic graft arteriovenous fistula. MDCT angiography images in 3D shaded-surface (A) and 2D maximum-intensity-projection (B) displays show proximal grade 1 stenosis (arrowhead), two lobulated aneurysms (open arrows) of graft, and grade 3 stenosis of draining vein (solid arrow). Digital subtraction angiography image (C) obtained 2 days later shows similar findings.

 


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  		Fig. 1B —56-year-old woman with insufficient flow of brachiobasilic graft arteriovenous fistula. MDCT angiography images in 3D shaded-surface (A) and 2D maximum-intensity-projection (B) displays show proximal grade 1 stenosis (arrowhead), two lobulated aneurysms (open arrows) of graft, and grade 3 stenosis of draining vein (solid arrow). Digital subtraction angiography image (C) obtained 2 days later shows similar findings.

 


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  		Fig. 1C —56-year-old woman with insufficient flow of brachiobasilic graft arteriovenous fistula. MDCT angiography images in 3D shaded-surface (A) and 2D maximum-intensity-projection (B) displays show proximal grade 1 stenosis (arrowhead), two lobulated aneurysms (open arrows) of graft, and grade 3 stenosis of draining vein (solid arrow). Digital subtraction angiography image (C) obtained 2 days later shows similar findings.

 


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  		Fig. 2A —47-year-old man with brachiobasilic polytetrafluoroethylene graft arteriovenous fistula who complained of swelling in left upper arm. MDCT angiography image in 3D shaded-surface display reveals aneurysm (arrow) with small neck originating from brachial artery.

 


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  		Fig. 2B —47-year-old man with brachiobasilic polytetrafluoroethylene graft arteriovenous fistula who complained of swelling in left upper arm. Axial image shows hematoma (open arrows) adjacent to aneurysm (solid arrow).

 


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  		Fig. 3 —60-year-old woman with insufficient flow of brachiobasilic arteriovenous fistula (AVF). MDCT angiography image in 3D volume-rendered display shows brachiobasilar AVF with grade 1 (white arrow) and grade 3 (black arrow) stenoses and large thrombus (open arrows) in draining vein.

 


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  		Fig. 4 —43-year-old man with radiocephalic arteriovenous fistula (AVF) who complained of distal forearm mass and left upper extremity swelling. MDCT angiography image in 3D shaded-surface display shows complete vascular tree of radiocephalic AVF with venous aneurysm (open arrow) associated with occlusion of left brachiocephalic vein (large arrow). Note collateral veins (small arrows) at left shoulder and neck regions are also clearly depicted.

 

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