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Review
. 2023 May 4;40(1):87-99.
doi: 10.1055/s-0043-1764430. eCollection 2023 Feb.

Percutaneous Creation of Dialysis Arteriovenous Fistula: Patient Selection and Ultrasound Mapping

Kedar G Sharbidre  1 , Lauren F Alexander  2 , Alian Al-Balas  3 , Michelle L Robbin  1
Affiliations
Review

Percutaneous Creation of Dialysis Arteriovenous Fistula: Patient Selection and Ultrasound Mapping

Kedar G Sharbidre et al. Semin Intervent Radiol. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Dr. Robbin Michelle: Philips Medical grant support paid to institution.

Figures

Fig. 1
Fig. 1
Longitudinal Grey scale ultrasound (US) images of the radial artery at wrist showing no (a), mild (b), and severe calcifications (c). (d) Spectral Doppler of the mid left radial artery showing high resistance low peak systolic velocity flow pattern suggesting more distal stenosis or occlusion. (e) Spectral Doppler of the left radial artery at wrist showing parvus tardus waveform suggesting proximal radial artery stenosis or occlusion. (f) Spectral Doppler of the right radial artery showing elevated peak systolic velocity and color aliasing (arrow) consistent with stenosis.
Fig. 2
Fig. 2
Transverse Gray scale ultrasound images of the right lower arm showing high brachial artery bifurcation. Paired ulnar and radial veins (UV and RV, respectively) are shown. UA, ulnar artery; RA, radial artery.
Fig. 3
Fig. 3
( a ) Spectral Doppler ultrasound of superficial palmar branch of radial artery showing flow reversal after proximal radial artery compression (arrow) suggesting complete arch and good collateral circulation. ( b ) Evaluation in a separate patient demonstrates absence of flow on compression (arrow) suggesting incomplete arch in a different patient ( b ).
Fig. 4
Fig. 4
( a ) Transverse gray scale ultrasound (US) images of the right arm demonstrating wall thickening (dotted white arrow) and linear intraluminal echogenicity (white arrow) within the cephalic vein, suggesting chronic post thrombotic change from prior cannulation. ( b ) Transverse Gray scale US images of the right mid arm showing anteroposterior measurement of the cephalic vein diameter and the depth measurement from skin surface. ( c ) Transverse Gray scale US images of the right arm antecubital region showing anteroposterior measurement of the basilic vein diameter. Note the low-level echoes within the basilic vein secondary to rouleaux formation due to stasis from tourniquet placement. ( d ) Transverse Gray scale US images of the right caudal arm showing anteroposterior measurement of the larger paired brachial vein.
Fig. 5
Fig. 5
( a ) Ultrasound (US) spectral Doppler image of the left lower neck showing normal color flow direction and pulsatility of left caudal IJV. ( b ) US spectral Doppler image of the right upper arm showing normal color flow direction and maintained pulsatility of left lateral subclavian vein.
Fig. 6
Fig. 6
( a ) Ultrasound spectral Doppler image of the left upper arm showing monophasic, slow waveform in the left subclavian vein with loss of normal pulsatility, which is highly indicative of central venous stenosis. ( b and c ) MR venogram with intravenous gadolinium, coronal images showing filling defect (white arrow) in the left innominate vein extending partially in the SVC suggesting thrombus, b . Narrowing of the mid and medial left subclavian vein (white arrowhead) in c .
Fig. 7
Fig. 7
( a ) Ultrasound color Doppler image of the right lower neck showing reversal of flow in the caudal right IJV suggesting central venous obstruction. ( b ) CT chest with IV contrast, coronal MPR showing focal stenosis (white arrow) of SVC at the tip of hemodialysis catheter.
Fig. 8
Fig. 8
(a) Ellipsys and (b) WavelinQ Access AV fistula creation. CV, Cephalic vein; BV, Basilic vein; Br.A & Br. V, Brachial artery and vein; MCV, Median cephalic vein; MBV, Median basilic vein; RA & RV, Radial artery and vein; UA & UV, Ulnar artery and ulnar veins. EC, Embolization coils in one of the paired brachia veins. *Asterix: Perforator.
Fig. 9
Fig. 9
(a) Ultrasound (US) spectral Doppler of the left radial artery 2 cm caudal to the brachial artery bifurcation showing normal peak systolic velocity and normal triphasic waveform. ( b ) Transverse gray scale US images of the right proximal forearm showing AP measurements of the radial artery (RA) and radial veins (RV) in transverse plane, ∼2 cm caudal to brachial artery bifurcation. The radial artery and one of the radial veins meet the criteria for placement of both the Ellipsys and WavelinQ devices. ( c ) Transverse gray scale US images of the right proximal forearm showing AP measurements of the ulnar artery (UA) and ulnar veins (UV) in transverse plane, ∼2 cm caudal to brachial artery bifurcation. The ulnar artery and both the ulnar veins meet the criteria for placement of both devices.
Fig. 10
Fig. 10
Schematic representation of the three most common anatomic variants of the superficial veins in the arm. (Based on Yammine K, Erić M. Patterns of the superficial veins of the cubital fossa: a meta-analysis. Phlebology 2017;32(6):403–414.) CV, cephalic vein; BV, basilic vein; MCV, median cephalic vein; MBV, median basilic vein; MAV, median antebrachial vein; MCuV, median cubital vein.
Fig. 11
Fig. 11
( a ) Transverse gray scale ultrasound (US) images of the right proximal forearm showing measurement of the shortest distance (calipers within red circle) between the perforator and pAVF radial artery. ( b ) Longitudinal gray scale US images of the right antecubital fossa showing measurement of the length of a perforator.
Fig. 12
Fig. 12
( a and b ) Transverse gray scale ultrasound images of the right basilic vein showing intraluminal echogenicity secondary to rouleaux phenomenon (arrow, a ) and showing complete compressibility (arrow, b ).
See this image and copyright information in PMC

References

    1. Johansen K L, Chertow G M, Foley R N.US Renal Data System 2020 Annual Data Report: epidemiology of kidney disease in the United States Am J Kidney Dis 202177(4, Suppl 1):A7–A8. - PMC - PubMed
    1. Allon M. Current management of vascular access. Clin J Am Soc Nephrol. 2007;2(04):786–800. - PubMed
    1. Roy-Chaudhury P, Kelly B S, Melhem M. Vascular access in hemodialysis: issues, management, and emerging concepts. Cardiol Clin. 2005;23(03):249–273. - PubMed
    1. Roy-Chaudhury P, Sukhatme V P, Cheung A K. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol. 2006;17(04):1112–1127. - PubMed
    1. Hemodialysis Fistula Maturation Study Group . Robbin M L, Greene T, Cheung A K. Arteriovenous fistula development in the first 6 weeks after creation. Radiology. 2016;279(02):620–629. - PMC - PubMed