Dialysis Fistula Malfunction Fluoroscopy Fistulography Hemodialysis Access Area of Interest Thrombosis of a hemodialysis vascular access (fistula or graft) connotes lack of blood flow and is a diagnosis that is readily made by physical examination [7]. Diagnostic fistulography is suggested for suspected thrombosis if there is an intention to perform an endovascular intervention on significant findings or if it is needed for surgical planning, according to the SIR Quality Improvement Guidelines [7]. The European Best Practice Guidelines Expert Group on Hemodialysis recommends against performing diagnostic fistulography without intention to intervene on significant findings [19]. Given that up to 90% of dialysis access thrombosis is caused by an underlying stenosis, fistulography performed before or after thrombolysis or thrombectomy can help detect and treat any anatomic stenosis within the dialysis access circuit [7]. US Duplex Doppler Hemodialysis Access Area of Interest There is no known evidence to support the use of diagnostic US once an AVF or AVG is suspected to be thrombosed on physical examination [5,7]. The role of US duplex Doppler has mainly been shown to be beneficial in the identification of stenoses and risk factors for hemodialysis access thrombosis [83]. To prevent adverse outcomes, the KDOQI guidelines suggest routine performance of diagnostic imaging, which includes Doppler US and fistulography when an abnormality is detected [5]. CTA Extremity Area of Interest With IV Contrast MDCT angiography has been shown to correlate well with DSA in evaluation of stenoses in hemodialysis patients with native AVF [17]. MDCT angiography has also been demonstrated to accurately diagnose stenoses in a dysfunctional AVF and AVG with a sensitivity of 95% [84]. In a more recent feasibility study, time-resolved dynamic CTA utilizing 3-phase imaging was compared to Doppler US in the evaluation of AVF and AVG.
Dialysis Fistula Malfunction. Dialysis Fistula Malfunction Fluoroscopy Fistulography Hemodialysis Access Area of Interest Thrombosis of a hemodialysis vascular access (fistula or graft) connotes lack of blood flow and is a diagnosis that is readily made by physical examination [7]. Diagnostic fistulography is suggested for suspected thrombosis if there is an intention to perform an endovascular intervention on significant findings or if it is needed for surgical planning, according to the SIR Quality Improvement Guidelines [7]. The European Best Practice Guidelines Expert Group on Hemodialysis recommends against performing diagnostic fistulography without intention to intervene on significant findings [19]. Given that up to 90% of dialysis access thrombosis is caused by an underlying stenosis, fistulography performed before or after thrombolysis or thrombectomy can help detect and treat any anatomic stenosis within the dialysis access circuit [7]. US Duplex Doppler Hemodialysis Access Area of Interest There is no known evidence to support the use of diagnostic US once an AVF or AVG is suspected to be thrombosed on physical examination [5,7]. The role of US duplex Doppler has mainly been shown to be beneficial in the identification of stenoses and risk factors for hemodialysis access thrombosis [83]. To prevent adverse outcomes, the KDOQI guidelines suggest routine performance of diagnostic imaging, which includes Doppler US and fistulography when an abnormality is detected [5]. CTA Extremity Area of Interest With IV Contrast MDCT angiography has been shown to correlate well with DSA in evaluation of stenoses in hemodialysis patients with native AVF [17]. MDCT angiography has also been demonstrated to accurately diagnose stenoses in a dysfunctional AVF and AVG with a sensitivity of 95% [84]. In a more recent feasibility study, time-resolved dynamic CTA utilizing 3-phase imaging was compared to Doppler US in the evaluation of AVF and AVG.