US Duplex Doppler Hemodialysis Access Area of Interest Duplex Doppler US reflects a unique ability to reliably evaluate the functional and structural characteristics of the peripheral vasculature. As such, it has become a well-established imaging modality for vascular access follow-up. Duplex Doppler US reflects a reliable means of assessing the velocity of the flow. KDOQI 2019 guidelines recognize the presence of established minimum US criteria for AVF maturity at 4 weeks that includes evaluation Dialysis Fistula Malfunction of the vessel diameter and flow parameters. Sonographic demonstration of a vessel diameter of 4 to 5 mm and blood flow of 400 to 500 mL/min has been associated with high reliability of the access in providing adequate dialysis [5]. For example, this includes a vein diameter of 6 mm, which is considered adequate. Given the need for a long enough access segment capable of supporting 2 dialysis access needles, a straight segment 10 cm or longer is needed. Finally, demonstration of the depth of the access <6 mm from the skin can also be demonstrated on duplex Doppler US [32]. Doppler US is particularly helpful in assessing the causes of nonmaturation of an AVF, such as the presence of stenoses in the access circuit or competing venous tributaries, and thus can be used to prospectively inform the needed percutaneous or surgical therapy [7]. A vein diameter of at least 5 mm and a palpable thrill are deemed sensitive predictors (83% and 96%, respectively) for successful future dialysis use [100]. Mufty et al [101] suggested that when physical examination, consisting of inspection, palpation, and auscultation was deemed insufficient to support a definitive diagnosis, subsequent diagnostic evaluations first by duplex US followed by angiography may be performed.
Dialysis Fistula Malfunction. US Duplex Doppler Hemodialysis Access Area of Interest Duplex Doppler US reflects a unique ability to reliably evaluate the functional and structural characteristics of the peripheral vasculature. As such, it has become a well-established imaging modality for vascular access follow-up. Duplex Doppler US reflects a reliable means of assessing the velocity of the flow. KDOQI 2019 guidelines recognize the presence of established minimum US criteria for AVF maturity at 4 weeks that includes evaluation Dialysis Fistula Malfunction of the vessel diameter and flow parameters. Sonographic demonstration of a vessel diameter of 4 to 5 mm and blood flow of 400 to 500 mL/min has been associated with high reliability of the access in providing adequate dialysis [5]. For example, this includes a vein diameter of 6 mm, which is considered adequate. Given the need for a long enough access segment capable of supporting 2 dialysis access needles, a straight segment 10 cm or longer is needed. Finally, demonstration of the depth of the access <6 mm from the skin can also be demonstrated on duplex Doppler US [32]. Doppler US is particularly helpful in assessing the causes of nonmaturation of an AVF, such as the presence of stenoses in the access circuit or competing venous tributaries, and thus can be used to prospectively inform the needed percutaneous or surgical therapy [7]. A vein diameter of at least 5 mm and a palpable thrill are deemed sensitive predictors (83% and 96%, respectively) for successful future dialysis use [100]. Mufty et al [101] suggested that when physical examination, consisting of inspection, palpation, and auscultation was deemed insufficient to support a definitive diagnosis, subsequent diagnostic evaluations first by duplex US followed by angiography may be performed.