The KDOQI guidelines defines a mature fistula as one that dependably provides the prescribed dialysis using 2 needles for greater than two-thirds of the dialysis sessions over a 4 consecutive week period [5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest Given that early detection and intervention of a nonmaturing AVF can mitigate early access failure, prompt identification is critical. While various noninvasive imaging strategies such as US remain helpful imaging tools for evaluation of a nonmaturing native AVF, fistulography has been often used with other authors citing it as the next step after an initial duplex Doppler US evaluation for suspected nonmaturation [94,95]. Diagnosis of an AVF may be performed via the traditional retrograde venous fistulography or via direct retrograde access of the perfusing brachial artery using a 3F micropuncture access [94]. One of the core benefits of using early fistulography in assessing a native AVF that has been deemed to be nonmaturing is that transvenous angioplasty may be in turn used to correct and achieve functional patency in most cases [96,97]. While the problems in maturation may often be predicted at the time of fistula creation (eg, efferent vein is small, <3 mm), the anatomic location of the principal lesion on angiography has been clearly demonstrated in the anastomosis segment, and juxta-anastomotic segments, with inflow arterial lesions ranging from 4% to 7% of cited studies [95,98]. Multiple reports have cited the benefits of using the percutaneous technique of fistulography to aid early identification of fistulas that are deemed as failing to mature followed by subsequent early treatment of the underlying causes. These subsequent endovascular techniques that may be warranted are readily facilitated and ultimately result in a functional fistula in most patients when this percutaneous imaging and treatment strategy is employed [96,97,99].
Dialysis Fistula Malfunction. The KDOQI guidelines defines a mature fistula as one that dependably provides the prescribed dialysis using 2 needles for greater than two-thirds of the dialysis sessions over a 4 consecutive week period [5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest Given that early detection and intervention of a nonmaturing AVF can mitigate early access failure, prompt identification is critical. While various noninvasive imaging strategies such as US remain helpful imaging tools for evaluation of a nonmaturing native AVF, fistulography has been often used with other authors citing it as the next step after an initial duplex Doppler US evaluation for suspected nonmaturation [94,95]. Diagnosis of an AVF may be performed via the traditional retrograde venous fistulography or via direct retrograde access of the perfusing brachial artery using a 3F micropuncture access [94]. One of the core benefits of using early fistulography in assessing a native AVF that has been deemed to be nonmaturing is that transvenous angioplasty may be in turn used to correct and achieve functional patency in most cases [96,97]. While the problems in maturation may often be predicted at the time of fistula creation (eg, efferent vein is small, <3 mm), the anatomic location of the principal lesion on angiography has been clearly demonstrated in the anastomosis segment, and juxta-anastomotic segments, with inflow arterial lesions ranging from 4% to 7% of cited studies [95,98]. Multiple reports have cited the benefits of using the percutaneous technique of fistulography to aid early identification of fistulas that are deemed as failing to mature followed by subsequent early treatment of the underlying causes. These subsequent endovascular techniques that may be warranted are readily facilitated and ultimately result in a functional fistula in most patients when this percutaneous imaging and treatment strategy is employed [96,97,99].