Under valid indications for tunneled dialysis catheter placement, the KDOQI guidelines suggests that when the duration of catheter use is anticipated to be prolonged (>3 months) without the anticipated use of AV access, a tunneled dialysis catheter may be placed in order of preference in the following vein, namely internal jugular, external jugular, femoral, subclavian, and lumbar veins, respectively [5]. In the absence of pathologic findings such as a CVS or devices such as pacemakers, tunneled dialysis catheter placement on the right side is preferred to the left side secondary to a more direct venous anatomy. If a single side demonstrates findings that restrict AV access creation but not catheter placement, that laterality ought to be utilized to preserve the contralateral side for creation of the intended AV access. Dialysis Fistula Malfunction US Duplex Doppler Hemodialysis Access Area of Interest There is minimal data to support US-guided endovascular thrombectomy or thrombolysis [80]. Fluoroscopically- guided endovascular interventions performed during fistulography are routine techniques employed to facilitate endovascular thrombectomy or thrombolysis. Several retrospective studies have shown the feasibility of performing US-guided endovascular thrombectomy or thrombolysis [80,91]. The largest series by Wakabayashi et al [80] reported a 97.4% technical success rate and a 91.9% primary patency rate in 455 cases of US-guided thrombectomy at 1-month. Major limitations include the lower sensitivity and specificity of US for the detection of underlying stenotic lesions compared to angiography. Variant 5: Failure of an upper or lower extremity arteriovenous fistula to mature within 2 months after creation. Initial imaging to guide interventional radiologic therapy options. Optimal hemodialysis is dependent on the presence of a mature, functioning AVF. A mature fistula may be defined as functionally mature or physiologically mature.
Dialysis Fistula Malfunction. Under valid indications for tunneled dialysis catheter placement, the KDOQI guidelines suggests that when the duration of catheter use is anticipated to be prolonged (>3 months) without the anticipated use of AV access, a tunneled dialysis catheter may be placed in order of preference in the following vein, namely internal jugular, external jugular, femoral, subclavian, and lumbar veins, respectively [5]. In the absence of pathologic findings such as a CVS or devices such as pacemakers, tunneled dialysis catheter placement on the right side is preferred to the left side secondary to a more direct venous anatomy. If a single side demonstrates findings that restrict AV access creation but not catheter placement, that laterality ought to be utilized to preserve the contralateral side for creation of the intended AV access. Dialysis Fistula Malfunction US Duplex Doppler Hemodialysis Access Area of Interest There is minimal data to support US-guided endovascular thrombectomy or thrombolysis [80]. Fluoroscopically- guided endovascular interventions performed during fistulography are routine techniques employed to facilitate endovascular thrombectomy or thrombolysis. Several retrospective studies have shown the feasibility of performing US-guided endovascular thrombectomy or thrombolysis [80,91]. The largest series by Wakabayashi et al [80] reported a 97.4% technical success rate and a 91.9% primary patency rate in 455 cases of US-guided thrombectomy at 1-month. Major limitations include the lower sensitivity and specificity of US for the detection of underlying stenotic lesions compared to angiography. Variant 5: Failure of an upper or lower extremity arteriovenous fistula to mature within 2 months after creation. Initial imaging to guide interventional radiologic therapy options. Optimal hemodialysis is dependent on the presence of a mature, functioning AVF. A mature fistula may be defined as functionally mature or physiologically mature.