MRA Extremity Area of Interest Without IV Contrast There is no identified relevant literature to support the use of MRA of the extremity without IV contrast in evaluation of suspected dysfunction of a hemodialysis access. MRV Extremity Area of Interest Without and With IV Contrast There is no identified relevant literature to support the use of MR venography (MRV) of the extremity without and with IV contrast in evaluation of suspected dysfunction of a hemodialysis access. MRV Extremity Area of Interest Without IV Contrast There is no identified relevant literature to support the use of MRV of the extremity without IV contrast in evaluation of suspected dysfunction of a hemodialysis access. Variant 2: Suspected dysfunction of the upper or lower extremity hemodialysis access (ie, arteriovenous fistula or graft) suggested by an abnormal clinical indicator or hemodynamic indicator (ie, reduction in dialysis vascular access blood flow rate or kinetics). Treatment and procedures. Fluoroscopy Fistulography Hemodialysis Access with Intervention Over 90% of dialysis access dysfunction is caused by an anatomic stenosis, which can be identified during diagnostic fistulography [7]. In the setting of a dysfunctional dialysis access, endovascular treatment of a stenosis found during diagnostic fistulography may be warranted. Numerous studies have shown that percutaneous endovascular interventions extend patency rates and reduce the need for surgical revision or abandonment of the dialysis access [22,35-42]. Endovascular interventions have the advantages of being minimally invasive, allowing the procedure to be performed in an outpatient setting. Endovascular interventions are associated with short procedure time, use of moderate sedation as opposed to general anesthesia, and allow for hemodialysis immediately after the procedure. In addition, they can be performed repeatedly without the need for adding graft material or shortening the access [35,38].
Dialysis Fistula Malfunction. MRA Extremity Area of Interest Without IV Contrast There is no identified relevant literature to support the use of MRA of the extremity without IV contrast in evaluation of suspected dysfunction of a hemodialysis access. MRV Extremity Area of Interest Without and With IV Contrast There is no identified relevant literature to support the use of MR venography (MRV) of the extremity without and with IV contrast in evaluation of suspected dysfunction of a hemodialysis access. MRV Extremity Area of Interest Without IV Contrast There is no identified relevant literature to support the use of MRV of the extremity without IV contrast in evaluation of suspected dysfunction of a hemodialysis access. Variant 2: Suspected dysfunction of the upper or lower extremity hemodialysis access (ie, arteriovenous fistula or graft) suggested by an abnormal clinical indicator or hemodynamic indicator (ie, reduction in dialysis vascular access blood flow rate or kinetics). Treatment and procedures. Fluoroscopy Fistulography Hemodialysis Access with Intervention Over 90% of dialysis access dysfunction is caused by an anatomic stenosis, which can be identified during diagnostic fistulography [7]. In the setting of a dysfunctional dialysis access, endovascular treatment of a stenosis found during diagnostic fistulography may be warranted. Numerous studies have shown that percutaneous endovascular interventions extend patency rates and reduce the need for surgical revision or abandonment of the dialysis access [22,35-42]. Endovascular interventions have the advantages of being minimally invasive, allowing the procedure to be performed in an outpatient setting. Endovascular interventions are associated with short procedure time, use of moderate sedation as opposed to general anesthesia, and allow for hemodialysis immediately after the procedure. In addition, they can be performed repeatedly without the need for adding graft material or shortening the access [35,38].