Doppler sonography evaluation of the complications of arteriovenous fistula in dialysis patients

Congress:

ECR 2020

Poster Number:

C-14769

Type:

Educational Exhibit

Keywords:

Vascular, Ultrasound physics, Ultrasound-Colour Doppler, Ultrasound-Power Doppler, Ultrasound-Spectral Doppler, Arterial access, Complications, Venous access, Fistula, Not applicable, Performed at one institution

Authors:

A. B. Onofre Chen¹, C. S. Kiebert¹, E. L. Politani¹, A. Cavalanti¹, P. C. Francolin¹, M. C. Chammas², G. G. Cerri¹; ¹São Paulo/BR, ²São Paulo, SP/BR

DOI:

10.26044/ecr2020/C-14769

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-14769

Fig. 1

Fig. 2: A.Gray scale mapping shows the anastomosis between the radial artery and...

Fig. 3: A.Gray scale mapping shows the anastomosis between the radial artery and...

Fig. 4: A.Brachiocephalic fistula with arterial and venous stenosis. Color Doppler...

Learning objectives

Explain the main sonographic findings in the evaluation of arteriovenous fistulas in dialysis patients. Discuss the main complications and dysfunction criteria associated with this vascular access. Establish protocols of the scanning and interpretation through the study with color Doppler that allows the characterization of these findings.

Background

An acquired arteriovenous fistulas (AVF) is the method of choice for vascular access in chronic renal failure patients under long-term hemodialysis. AVF creation is a procedure that connects an artery to a superficial vein. It is preferably done as distal as possible in the non-dominant arm, so the proximal vessels are preserved for future access. The fistulas are usually radial-cephalic (wrist) and brachial-cephalic (elbow). This can either be a native AVF or a synthetic connection using PTFE (polytetrafluoroethylene) graft. Native ones are preferable due to...

Findings and procedure details

After the creation of an AVF, complications might occur, such as: -Failing to mature: After the vascular access is created it needs to mature. Four months is the maximum interval for AVF mature. Many fistulas do not mature appropriately for being used in dialysis and may need correction or another intervention. The objective quantitative criteria to assess the maturation of fistulas are: Minimum Diameter of 4 mm (vein) Flow > 500 ml/min. Depth of up to 5 mm from the skin -Thrombosis: can be characterized...

Conclusion

Fistula complications are associated with morbidity, mortality and a high economic burden. Doppler ultrasound is the main tool of diagnostic imaging to analyze the arteriovenous fistulas. Problems in the AVF maturation or possible complications that may compromise their viability shall be described in the final report. Their early recognition offers the opportunity of correction or appropriate treatment.

Personal information and conflict of interest

A. B. Onofre Chen; São Paulo/BR - nothing to disclose C. S. Kiebert; São Paulo/BR - nothing to disclose E. L. Politani; São Paulo/BR - nothing to disclose A. Gomes Cavalanti; Sao Paulo/BR - nothing to disclose M. C. Chammas; São Paulo/BR - nothing to disclose G. G. Cerri; São Paulo/BR - nothing to disclose P. C. Françolin; Sao Paulo/BR - nothing to disclose

References

L. C. C. Chierighini, P. C. Francolin, M. C. Chammas, G. G. Cerri; Evaluation of hemodialysis arteriovenous fistula before and after surgery: Teaching points. ECR 2014 / C-0625. São Paulo/BR Junior, Milton Alves das Neves. Acesso vascular para hemodiálise: o que há de novo? Vasc Bras. 2013 Jul.-Set.; 12(3):221-225 Robbin M.L., Chamberlain N.E., Lockhart M.E., Gallichio M.H., Young C.Y., Deierhoi M.H., Allon M. Hemodialysis Arteriovenous Fistula Maturity: US evaluation. 10.1148/radiol.2251011367. Radiology 2002; 225:59–64. Wiese P., Nonnast-Daniel B. Colour Doppler ultrasound in dialysis access. Nephrol Dial...