As high as 90% of accesses with abnormal physical examinations will have an underlying clinically significant finding on imaging [10]; and 2) surveillance, performed periodically with the aid of noninvasive and invasive device-based methods to assess blood access flow rate (Qa), access recirculation, and dialysis venous pressure; c) diagnostic imaging, such as Doppler ultrasound (US) or diagnostic fistulography upon detection or suspicion of an access abnormality [4]. In this document, when it is noted that the entire extremity is imaged or treated, for the upper extremity, this is assumed to cover the shoulder through the hand, and for the lower extremity, this is assumed to cover the hip through the foot. Moreover, when surgical consultation is discussed as an intervention, it connotes consulting or referring a patient to a surgeon, be they vascular or transplant surgeon, in order to assess the patient for the specific clinical presentation in question. This may be in settings where a surgical procedure such as new access creation, access revision, or access ligation is deemed to be a fitting therapy. Fistulography allows for comprehensive imaging evaluation of the entire hemodialysis vascular access and is routinely conducted with iodinated contrast material [13]. Ehrman et al [14] suggests that when using iodinated contrast material as the reference standard, the sensitivity, specificity, and accuracy of carbon dioxide is 94%, 58%, and 75%, respectively. A shortcoming is that carbon dioxide is not as reliable in assessing venous anatomy and may overestimate the extent of a visualized stenosis. In addition, when given intra-arterially, there is a possibility that carbon dioxide may create a vapor lock with resultant transient ischemia or loss of consciousness or other neurologic Dialysis Fistula Malfunction events due to its passing into the cerebral arterial circulation [15,16]. As such, it is not used in retrograde or reflux techniques to image the arterial anastomosis.
Dialysis Fistula Malfunction. As high as 90% of accesses with abnormal physical examinations will have an underlying clinically significant finding on imaging [10]; and 2) surveillance, performed periodically with the aid of noninvasive and invasive device-based methods to assess blood access flow rate (Qa), access recirculation, and dialysis venous pressure; c) diagnostic imaging, such as Doppler ultrasound (US) or diagnostic fistulography upon detection or suspicion of an access abnormality [4]. In this document, when it is noted that the entire extremity is imaged or treated, for the upper extremity, this is assumed to cover the shoulder through the hand, and for the lower extremity, this is assumed to cover the hip through the foot. Moreover, when surgical consultation is discussed as an intervention, it connotes consulting or referring a patient to a surgeon, be they vascular or transplant surgeon, in order to assess the patient for the specific clinical presentation in question. This may be in settings where a surgical procedure such as new access creation, access revision, or access ligation is deemed to be a fitting therapy. Fistulography allows for comprehensive imaging evaluation of the entire hemodialysis vascular access and is routinely conducted with iodinated contrast material [13]. Ehrman et al [14] suggests that when using iodinated contrast material as the reference standard, the sensitivity, specificity, and accuracy of carbon dioxide is 94%, 58%, and 75%, respectively. A shortcoming is that carbon dioxide is not as reliable in assessing venous anatomy and may overestimate the extent of a visualized stenosis. In addition, when given intra-arterially, there is a possibility that carbon dioxide may create a vapor lock with resultant transient ischemia or loss of consciousness or other neurologic Dialysis Fistula Malfunction events due to its passing into the cerebral arterial circulation [15,16]. As such, it is not used in retrograde or reflux techniques to image the arterial anastomosis.