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Review
. 2014 Jul 11;17(4):253-63.
doi: 10.1007/s40477-014-0113-6. eCollection 2014 Dec.

Color Doppler ultrasound and arteriovenous fistulas for hemodialysis

Pasquale Zamboli  1 , Fulvio Fiorini  2 , Alessandro D'Amelio  3 , Pasquale Fatuzzo  4 , Antonio Granata  5
Affiliations
Review

Color Doppler ultrasound and arteriovenous fistulas for hemodialysis

Pasquale Zamboli et al. J Ultrasound. .

Abstract
in English, Italian

Native arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. Compared with grafts and central venous catheters, AVFs last longer and are associated with fewer complications. The widespread use of the Doppler ultrasound (DUS) has increased the number of patients who are eligible for AVF by facilitating the identification of vessels that are suitable for fistula construction (preoperative vascular mapping). DUS can also extend native AVF survival by improving the early detection of complications (post-operative surveillance). It is the only imaging modality that furnishes both morphological and functional data on the native vascular access, and it is also the only imaging tool that can be used directly by the surgeon, an indisputable advantage. This review examines the numerous roles played by DUS in the construction and postoperative follow-up of AVFs, including preoperative vascular mapping, AVF maturation, and surveillance.

La FAV confezionata con vasi nativi rappresenta l’accesso vascolare di scelta per il paziente emodializzato in quanto, a parità di flusso, presenta minore incidenza di complicanze e più lunga sopravvivenza rispetto alle protesi ed ai cateteri venosi centrali. L’avvento del DUS nell’armamentario di chi si occupa di chirurgia degli accessi vascolari ha, da un lato, aumentato il numero di pazienti in cui si riesce a confezionare una FAV con vasi nativi (grazie all’individuazione di vasi idonei all’intervento mediante il mapping pre-chirurgico), e, dall’altro, ha migliorato la sopravvivenza delle FAV grazie alla diagnosi precoce (monitoraggio post-operatorio) delle complicanze dell’accesso vascolare. L’eco-color-Doppler è l’unica tecnica in grado di dare informazioni sia morfologiche che di funzionalità (flusso) dell’accesso vascolare; inoltre, è l’unica tecnica (tra quelle di diagnostica per immagini) direttamente gestibile dal chirurgo e ciò rappresenta sicuramente un valore aggiunto. Questa review fornisce una panoramica sulle possibili applicazioni del DUS nell’ambito del confezionamento e del follow-up delle FAV, con particolare riferimento al mapping pre-chirurgico, alla maturazione della FAV e al monitoraggio/sorveglianza della FAV.

Keywords: AVF monitoring and surveillance; Access flow volume measurement; Arteriovenous fistula (AVF); Doppler ultrasound (DUS); Preoperative vascular mapping.

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Figures

Fig. 1
Fig. 1
Reactive hyperemia test. Left ischemic phase with fist closed and corresponding Doppler spectrum, Right Doppler spectrum during the reactive hyperemia phase with the hand opened
Fig. 2
Fig. 2
Examples of preoperative vascular mapping. Left arterial mapping, right venous mapping
Fig. 3
Fig. 3
Calculation of the AVF flow volume. Left theoretical basis of the formula used to calculate blood flow volume of a blood vessel. Right example of AVF flow volume calculated at the level of the brachial artery, manually with the proposed formula (AVF flow volume) and with scanner software (“Flow by diameter”)
Fig. 4
Fig. 4
Longitudinal ultrasound scans of the anastomotic region of various AVF types. Top side-to-end AVF (S-E), Center side-to-side AVF (S-S), Bottom end-to-end AVF (E-E)
See this image and copyright information in PMC

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