Arteriovenous fistula (AVF) is currently the hemodialysis access with the longest life expectations for the patients. However, even the AVF is at risk for many complications, especially the development of stenosis. The latter can not only lead to inadequate hemodialysis but also lead to AVF thrombosis. Duplex Doppler ultrasonography is a very precise method, in the hands of experienced professionals, for the diagnosis of AVF complications. In this review, we summarize the ultrasound diagnostic criteria of significant stenoses and their indication for procedural therapy.

• Keywords
• arteriovenous fistula, arteriovenous graft, hemodialysis, vascular ultrasonography,
• Publication type
• Journal Article MeSH
• Review MeSH

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some.Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

• Keywords
• AV fistula, dialysis, dialysis access-related distal ischaemia, techniques and procedures, ultrasonography–Doppler evaluation,
• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Renal Dialysis MeSH
• Ischemia diagnostic imaging   etiology   therapy   MeSH
• Humans MeSH
• Ligation MeSH
• Vascular Patency MeSH
• Hand MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Chronic hemodialysis therapy required regular entry into the patient's blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.

• Keywords
• Hemodialysis, arteriovenous fistula, arteriovenous graft, hemodialysis vascular access, ultrasonography,
• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Renal Dialysis MeSH
• Ultrasonography, Doppler, Duplex MeSH
• Humans MeSH
• Graft Occlusion, Vascular diagnostic imaging   etiology   therapy   MeSH
• Vascular Patency MeSH
• Ultrasonography MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: Chronic heart failure is very common in hemodialyzed patients due to several factors such as intermittent volume overload, anemia, and hypertension. Dialysis access flow is usually considered to have a minor effect. We hypothesized that creation of dialysis access with "normal" flow would lead to elevation of B-type natriuretic peptide (BNP), which is a sensitive marker of heart failure. METHODS: We included subjects with a newly created, well-functioning vascular access and normal left ventricular ejection fraction. They were examined before access creation (baseline), then again 6 weeks and 6 months after the surgery. Only subjects with access flow (Qa) < 1500 ml/min were included. Changes of BNP levels and their relation to access flow were studied. RESULTS: We examined 35 subjects aged 60.6 +/- 13.5 years. Qa was 789 +/- 361 and 823 +/- 313 ml/min at 6 weeks and 6 months after the surgery, respectively. Within 6 weeks after access creation, BNP rose from 217 (294) to 267 (550) ng/l (median (quartile range)) with P = 0.003. Qa was significantly related to BNP levels 6 weeks after access creation (r = 0.37, P = 0.036). Six months after access creation, there was only a trend of BNP decrease (235 (308) ng/l, P = 0.44). Creatinine, blood urea nitrogen and hemoglobin levels as well as patients' weight did not change significantly. CONCLUSIONS: Creation of dialysis access with "normal" flow volume leads to significant increase of BNP, which is related to the value of access flow. The increase of BNP probably mirrors worsening of clinically silent heart failure.

• MeSH
• Analysis of Variance MeSH
• Arteriovenous Shunt, Surgical * MeSH
• Biomarkers blood   MeSH
• Time Factors MeSH
• Kidney Failure, Chronic blood   therapy   MeSH
• Renal Dialysis adverse effects   methods   MeSH
• Ventricular Dysfunction, Left blood   etiology   physiopathology   MeSH
• Risk Assessment MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Natriuretic Peptide, Brain analysis   blood   MeSH
• Normal Distribution MeSH
• Disease Progression MeSH
• Regression Analysis MeSH
• Renal Circulation physiology   MeSH
• Aged MeSH
• Sensitivity and Specificity MeSH
• Heart Failure blood   etiology   physiopathology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Names of Substances
• Biomarkers MeSH
• Natriuretic Peptide, Brain MeSH