Intravenous digital subtraction angiography (DSA) of hemodialysis access fistulae

Hemodialysis access fistulae or grafts are subject to a variety of complications, including thrombosis, stenoses, and aneurysm or pseudoaneurysm formation. The usual radiologic methods to evaluate these problems consist of retrograde venous angiography or standard femoral or brachial arteriography. Both are invasive, and may traumatize the artery or graft. Six patients with internal blood access were studied using digital subtraction angiography; five using a central venous injection and one with direct graft injection. Preliminary results indicate that intravenous digital subtraction angiography (IV-DSA) can depict the anatomy of access fistula with adequate spatial resolution. Pathologic entities (stenoses, aneurysms) can be demonstrated, as well as other findings of uncertain clinical significance (kinks and webs). In addition, hemodynamic data can be inferred from the near-physiologic sequence of vessel opacification. Methods are in development that will allow determination of absolute blood flow in pertinent vessels via IV-DSA. There were no complications in this small series, and all examinations were performed on outpatients utilizing standard technique.