Reconsidering physical examination of dysfunctional arteriovenous fistula for hemodialysis

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  • 動静脈瘻狭窄の理学的所見を再考する
  • ドウ ジョウミャクロウ キョウサク ノ リガクテキ ショケン オ サイコウ スル

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Abstract

There have been very few systematic reports on physical examination procedures for dysfunctional arteriovenous fistula (AVF), and for the most part these are biased toward auscultation in Japan. The significance of physical examination in dysfunctional AVF is studied in this paper. The AVF cases were divided into two groups according to the observation procedure used: The first group was retrospectively investigated by conventional methods based on auscultation between July 1996 and December 2004, and the second group was prospectively evaluated by overall physical examination including inspection and palpation between January and December 2005. Physical findings were observed in cases showing venous stenosis of 60% or greater decrease in lumen diameter measurement on diagnostic angiography. There were 181 findings obtained from 102 stenotic AVF in the former group and 69 findings from 31 AVF in the latter group. Furthermore, AVF venous stenosis was classified into three types: 1) juxta-anastomotic type, 2) upstream type and 3) mixed type of former two types. In the first group, serious findings such as blood flow failure including occlusion was relatively prominent. In the second group, serious findings decreased substantially. In the former group, three types of stenosis could not be distinguished by auscultation. Meanwhile in the second group, each type showed distinctive findings: attenuation of the first thrill on juxta-anastomotic type, a firm dilated pulsatile vein and second thrill on upstream type, and second thrill accompanied by slight venous dilatation on the mixed type, respectively. Physical examination with the eyes, hands and ears makes early diagnosis of access failure or stenosis easy and precise, and thus helps to improve access by percutaneous transluminal angioplasty.

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