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Thrombus stiffness as an independent predictor of endovascular treatment success in hemodialysis fistulas: a study using ultrasound elastography
Sarhun Zirek1 , Gökhan Mert Özyurt1 , Alptuğ Özen1 , Refik Olmaz1, Kaan Esen2
1Mersin City and Research Hospital, Mersin, Turkey
2Mersin University Hospital, Department of Radiology, Mersin, Turkey, Mersin, Turkey
Corresponding Author: Sarhun Zirek ,Tel: +905318255828, Fax: +90 3242251010, Email: sarhun.zirek@hotmail.com
Received: September 14, 2024;  Accepted: January 21, 2025.  Published online: January 21, 2025.
ABSTRACT
Purpose:
This study aims to evaluate the prognostic value of thrombus stiffness measured by strain elastography in independently predicting endovascular treatment success in thrombosed hemodialysis fistulas.
Methods:
The study was conducted with a retrospective observational design. Forty-nine patients with chronic kidney disease undergoing hemodialysis and experiencing fistula dysfunction were included., We evaluated various factors, including patient age, gender, comorbidities, AVF type, use of antiplatelet agents, duration of thrombosed AVF dysfunction, thrombus length, thrombus stiffness, and thrombus SR (strain ratio). Thrombus stiffness was measured using strain ultrasound elastography.
Results:
Among these, the duration of thrombosed AVF dysfunction, thrombus stiffness, and thrombus SR were statistically significant predictors of treatment success (p = 0.001), while the other factors were not. Thrombus stiffness and strain ratio, assessed by two independent radiologists with excellent inter-reader agreement, demonstrated high reliability. The optimal SR cut-off for treatment success was 1.4 (sensitivity 0.95, specificity 0.90, AUC 0.935). The multivariable logistic regression analysis revealed that both thrombus SR and thrombus stiffness significantly influence the dependent variable, with p-values of 0.003 and 0.007, respectively. A one-unit increase in the thrombus SR results in a 93.7% reduction in the likelihood of the outcome, while a similar increase in thrombus stiffness leads to a 80.6% reduction, highlighting their importance as prognostic factors in clinical settings.
Conclusion:
This study demonstrated the assessment of thrombus stiffness in thrombosed hemodialysis AVFs using strain ultrasound elastography and its correlation with treatment success.
Keywords: Strain elastography; Arteriovenous fistula; Percutaneous transluminal angioplasty; Endovascular treatment; Thrombus stiffness
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