Ferumoxytol MR angiography vs Duplex ultrasound for vascular mapping before arteriovenous fistula surgery for hemodialysis

Stoumpos, S., Tan, A., Hall Barrientos, P., Stevenson, K., Thomson, P., Kasthuri, R., Radjenovic, A. , Kingsmore, D., Roditi, G. and Mark, P. (2020) Ferumoxytol MR angiography vs Duplex ultrasound for vascular mapping before arteriovenous fistula surgery for hemodialysis. Radiology, (doi: 10.1148/radiol.2020200069) (PMID:32692301) (Early Online Publication)

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Abstract

Ferumoxytol-enhanced68 MR angiography was superior to duplex US in the detection of central vein stenosis and arterial disease that correlated with outcomes of arteriovenous fistula surgery for hemodialysis. Background: Duplex US is performed routinely for vascular mapping prior to arteriovenous fistula (AVF) creation for hemodialysis but cannot demonstrate the central vasculature. Ferumoxytol, an iron oxide nanoparticle, provides an alternative to gadolinium contrast material for MR angiography for safe use in chronic kidney disease (CKD). Purpose: To assess the clinical utility of ferumoxytol-enhanced MR angiography compared with duplex US for vascular mapping before upper limb AVF creation in participants with CKD. Materials and Methods: In a prospective comparative study (ClinicalTrials.gov: NCT02997046) from December 2016 to August 2018, participants with CKD underwent ferumoxytol-enhanced MR angiography and duplex US. Two independent readers evaluated vessels for diameter, stenosis or occlusion, arterial disease, and central stenosis. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess intra- and interreader variability. On the basis of accepted standards for AVF creation, an algorithm was developed to predict AVF outcome based on imaging findings. Multivariable regression models used AVF success as the dependent variable and age, sex, and duplex US or ferumoxytol-enhanced MR angiography findings as independent variables. Results: Fifty-nine participants with CKD (mean age, 59 years ± 13 [standard deviation]; 30 women) were evaluated. A total of 51 fistulas were created, of which 24 (47%) were successful. Ferumoxytol-enhanced MR angiography showed excellent inter- and intrareader repeatability (ICC, 0.84–0.99) for all variables assessed. In addition to revealing 15 central vasculature stenoses, ferumoxytol-enhanced MR angiography resulted in characterization of 88 of 236 (37%) of the arterial sections examined as unsuitable for AVF creation compared with 61 of 236 (26%) sections with duplex US (P = .01). Ferumoxytol-enhanced MR angiography independently predicted AVF success in models including (odds ratio, 6.5; 95% confidence interval: 1.7, 25; P = .006) and those excluding (odds ratio, 4.6; 95% confidence interval: 1.3, 17; P = .02) the central vasculature. Conclusion: In addition to enabling identification of central vessel pathologic features, ferumoxytol-enhanced MR angiography revealed peripheral arterial disease not recognized with duplex US and was more predictive than duplex US of the outcome of arteriovenous fistula surgery.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Kingsmore, Mr David and Mark, Dr Patrick and Tan, Dr Alfred and Stoumpos, Dr Sokratis and Hall Barrientos, Dr Pauline and Thomson, Dr Peter and Roditi, Dr Giles and Stevenson, Dr Karen and Kasthuri, Dr Ram and Radjenovic, Dr Aleksandra
Authors: Stoumpos, S., Tan, A., Hall Barrientos, P., Stevenson, K., Thomson, P., Kasthuri, R., Radjenovic, A., Kingsmore, D., Roditi, G., and Mark, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Radiology
Publisher:Radiological Society of North America
ISSN:0033-8419
ISSN (Online):1527-1315
Published Online:21 July 2020

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