Clinical monitoring and surveillance of the mature hemodialysis arteriovenous fistula
- Michael Allon, MD
Michael Allon, MD
- Professor of Medicine
- University of Alabama at Birmingham
- Section Editors
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
- David L Cull, MD
David L Cull, MD
- Section Editor — Arterial and Venous Access
- Clinical Professor, Department of Surgery
- University of South Carolina School of Medicine
Arteriovenous fistulas (AVFs) are capable of providing rapid extracorporeal blood flow that is necessary for hemodialysis; however, vascular stenosis is common and can lead to inadequate hemodialysis or fistula thrombosis if not identified and treated in a timely fashion.
Issues surrounding monitoring and surveillance of hemodialysis AVFs are reviewed here. Similar issues for hemodialysis AV grafts are discussed separately. (See "Monitoring and surveillance of hemodialysis arteriovenous grafts to prevent thrombosis".)
RATIONALE FOR MONITORING AND SURVEILLANCE OF AV FISTULAS
Nearly all thrombosed mature fistulas have an underlying stenotic lesion. This was shown in a series of 93 consecutive clotted fistulas in which 100 percent had an underlying stenosis . (See "Failure of the mature hemodialysis arteriovenous fistula".)
Although angiography is the most sensitive and specific imaging modality to identify and characterize stenotic vascular lesions, it is expensive and invasive [2-6]. For screening, noninvasive assessment is preferred to first identify fistulas with a high likelihood of stenosis. Arteriovenous fistulas (AVFs) with sufficiently abnormal screening tests would then undergo diagnostic angiography and, if indicated, treatment. Clinical monitoring and surveillance are currently used to screen for vascular stenotic lesions.
●Clinical monitoring (see 'Clinical monitoring' below)
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- RATIONALE FOR MONITORING AND SURVEILLANCE OF AV FISTULAS
- CLINICAL MONITORING
- Routine examination
- Problems with dialysis
- Decreased Kt/V
- Intra-access flow rate
- Duplex ultrasound
- Static dialysis venous pressure
- Assessing for recirculation
- INDICATIONS FOR ANGIOGRAPHY REFERRAL
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS