Adjuvant duplex US and/or phlebography was offered when physical examination was equivocal. AVF maturation was also confirmed by US and physical examination of the AVF. If indicated; however, a salvage intervention was performed or when a salvage procedure was not possible, a new AVF was created. Duplex US evaluation was also performed to support triaging and screening in 41.4% of reinterventions. Ultimately, with duplex US at the core of the surveillance program, a functional success rate of 94.2% was accomplished [101]. The evidence suggests that the critical role of US is centered in surveillance and flagging of the immature at-risk AVF, diagnostic in determining the cause of failed maturity, or in determining the need for reintervention [100,107,109]. Variant 7: Clinical suspicion of central venous stenosis or occlusion suggested by swelling (ie, soft tissue edema) of the extremity ipsilateral to the upper or lower extremity hemodialysis access, with or without the development of venous collaterals. Initial imaging to guide interventional radiologic therapy options. The presence of an occlusion or hemodynamically significant stenoses in any of the major central or intrathoracic veins, including the internal jugular, subclavian, brachiocephalic veins, or SVC can degrade the function of an AV Dialysis Fistula Malfunction access, resulting in ineffective hemodialysis. These may occur in 5% to 50% of cases. Such lesions may also precipitate high venous pressures secondary to an increase in flow within the AVF, with associated broad symptom severity including chest wall and central ipsilateral extremity venous collaterals, dermatosclerosis, arm edema, ulceration, and SVC syndrome. The presence of such stenoses in the central venous outflow may result in prolonged bleeding after decannulation post dialysis, with or without an increase in venous pressures noted during monitoring of the access or increased AV access recirculation [5].
Dialysis Fistula Malfunction. Adjuvant duplex US and/or phlebography was offered when physical examination was equivocal. AVF maturation was also confirmed by US and physical examination of the AVF. If indicated; however, a salvage intervention was performed or when a salvage procedure was not possible, a new AVF was created. Duplex US evaluation was also performed to support triaging and screening in 41.4% of reinterventions. Ultimately, with duplex US at the core of the surveillance program, a functional success rate of 94.2% was accomplished [101]. The evidence suggests that the critical role of US is centered in surveillance and flagging of the immature at-risk AVF, diagnostic in determining the cause of failed maturity, or in determining the need for reintervention [100,107,109]. Variant 7: Clinical suspicion of central venous stenosis or occlusion suggested by swelling (ie, soft tissue edema) of the extremity ipsilateral to the upper or lower extremity hemodialysis access, with or without the development of venous collaterals. Initial imaging to guide interventional radiologic therapy options. The presence of an occlusion or hemodynamically significant stenoses in any of the major central or intrathoracic veins, including the internal jugular, subclavian, brachiocephalic veins, or SVC can degrade the function of an AV Dialysis Fistula Malfunction access, resulting in ineffective hemodialysis. These may occur in 5% to 50% of cases. Such lesions may also precipitate high venous pressures secondary to an increase in flow within the AVF, with associated broad symptom severity including chest wall and central ipsilateral extremity venous collaterals, dermatosclerosis, arm edema, ulceration, and SVC syndrome. The presence of such stenoses in the central venous outflow may result in prolonged bleeding after decannulation post dialysis, with or without an increase in venous pressures noted during monitoring of the access or increased AV access recirculation [5].