 Introduction/Background Chronic kidney disease is a common disease that as of 2018 affected 14.9% of the surveyed adult United States population [1]. Chronic kidney disease can result in end stage renal disease, a condition with high morbidity and mortality that affects 725,000 patients in the United States as of 2016 [2]. End stage renal disease patients account for 7.2% of paid Medicare claims at a cost of $35.4 billion, a cost that is increasing every year [2]. In the United States, hemodialysis persists as the single most prevalent mode of renal replacement therapy. Hemodialysis care alone resulted in $28 billion in Medicare costs in 2016 [2]. A stenosis that develops secondary to neointimal hyperplasia becomes the primary precipitator of a vascular access failure. Such stenoses augment pressure within the access and decrease blood flow. If the stenosis is hemodynamically significant and left untreated, it can result in thrombosis of the access. Access thrombosis is the primary cause of loss of vascular access patency and is associated with an increase in health care expenditure and compromise of quality of life [9]. The occurrence of a stenosis is an event that recurs throughout the life of the access. While a vein-graft anastomosis in a patient with an AVG or juxta-anastomotic region in a patient with an AVF represent the sites with high propensity for stenosis formation, these lesions may occur at any point within the The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Dialysis Fistula Malfunction access system, notwithstanding central and feeding arteries.
Dialysis Fistula Malfunction.  Introduction/Background Chronic kidney disease is a common disease that as of 2018 affected 14.9% of the surveyed adult United States population [1]. Chronic kidney disease can result in end stage renal disease, a condition with high morbidity and mortality that affects 725,000 patients in the United States as of 2016 [2]. End stage renal disease patients account for 7.2% of paid Medicare claims at a cost of $35.4 billion, a cost that is increasing every year [2]. In the United States, hemodialysis persists as the single most prevalent mode of renal replacement therapy. Hemodialysis care alone resulted in $28 billion in Medicare costs in 2016 [2]. A stenosis that develops secondary to neointimal hyperplasia becomes the primary precipitator of a vascular access failure. Such stenoses augment pressure within the access and decrease blood flow. If the stenosis is hemodynamically significant and left untreated, it can result in thrombosis of the access. Access thrombosis is the primary cause of loss of vascular access patency and is associated with an increase in health care expenditure and compromise of quality of life [9]. The occurrence of a stenosis is an event that recurs throughout the life of the access. While a vein-graft anastomosis in a patient with an AVG or juxta-anastomotic region in a patient with an AVF represent the sites with high propensity for stenosis formation, these lesions may occur at any point within the The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Dialysis Fistula Malfunction access system, notwithstanding central and feeding arteries.