The loss of AVF was decreased in the group preemptively treated with PTA when compared to the observation alone group, 5 (18%) versus 13 (43%). These correlated to AVF loss rates [event/AVF-year] of 0.066 and 0.186; P = . 041 [5]. US Duplex Doppler Hemodialysis Access Area of Interest Recent evidence supports the safety and efficacy of US-guided interventions for dysfunctional hemodialysis access. Stenotic lesions within the dialysis vascular access circuit can be treated with US-guided balloon angioplasty. In one retrospective study, Wakabayashi et al [80] reported a 97.1% technical and clinical success rate in the US- guided treatment of 4,414 cases of stenosis causing dysfunctional dialysis access. Additional studies report success rates of 92% to 98% for US-guided percutaneous balloon angioplasty of stenoses within the dialysis vascular access circuit [29,30,81]. US-guided interventions allow for such procedures to be performed in an office-based outpatient setting. Major limitations include the difficulty in evaluating for and treating central venous stenoses, lower sensitivity, and specificity of US for the detection of stenotic lesions compared to angiography. While Wakabayashi et al [80] reported identifying and treating central venous stenoses by using a smaller US probe in the intercostal space, the other studies exclude central venous stenosis (CVS). Variant 3: Suspected thrombosis of the upper or lower extremity hemodialysis access, marked by absent pulse and thrill on physical examination. Initial imaging to guide interventional radiologic therapy options. The presence of an occlusive thrombosis reflects a terminal event in the life of a failing AV access. It represents 65% to 85% of all cases of access abandonments. While the precipitating cause of the provocative terminal is often clear, such as venous outflow stenoses or low flow in the case of an AVG, a patient may present with a thrombosis without any obvious mechanism [5,82].
Dialysis Fistula Malfunction. The loss of AVF was decreased in the group preemptively treated with PTA when compared to the observation alone group, 5 (18%) versus 13 (43%). These correlated to AVF loss rates [event/AVF-year] of 0.066 and 0.186; P = . 041 [5]. US Duplex Doppler Hemodialysis Access Area of Interest Recent evidence supports the safety and efficacy of US-guided interventions for dysfunctional hemodialysis access. Stenotic lesions within the dialysis vascular access circuit can be treated with US-guided balloon angioplasty. In one retrospective study, Wakabayashi et al [80] reported a 97.1% technical and clinical success rate in the US- guided treatment of 4,414 cases of stenosis causing dysfunctional dialysis access. Additional studies report success rates of 92% to 98% for US-guided percutaneous balloon angioplasty of stenoses within the dialysis vascular access circuit [29,30,81]. US-guided interventions allow for such procedures to be performed in an office-based outpatient setting. Major limitations include the difficulty in evaluating for and treating central venous stenoses, lower sensitivity, and specificity of US for the detection of stenotic lesions compared to angiography. While Wakabayashi et al [80] reported identifying and treating central venous stenoses by using a smaller US probe in the intercostal space, the other studies exclude central venous stenosis (CVS). Variant 3: Suspected thrombosis of the upper or lower extremity hemodialysis access, marked by absent pulse and thrill on physical examination. Initial imaging to guide interventional radiologic therapy options. The presence of an occlusive thrombosis reflects a terminal event in the life of a failing AV access. It represents 65% to 85% of all cases of access abandonments. While the precipitating cause of the provocative terminal is often clear, such as venous outflow stenoses or low flow in the case of an AVG, a patient may present with a thrombosis without any obvious mechanism [5,82].