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Clinical monitoring and surveillance of the mature hemodialysis arteriovenous fistula

Michael Allon, MD
Section Editors
Jeffrey S Berns, MD
David L Cull, MD
Deputy Editors
Alice M Sheridan, MD
Kathryn A Collins, MD, PhD, FACS


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".)


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 [1]. (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. 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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Literature review current through: Nov 2017. | This topic last updated: May 12, 2017.
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