Role of Duplex Ultrasound in Dialysis Access Surveillance

Abstract

Dialysis access dysfunction and failure is common in the end-stage renal disease patient requiring hemodialysis. Problems included failure of access maturation, conduit injury caused by cannulation, thrombosis, inadequate volume flow, and aneurysmal degeneration. Duplex ultrasound is an accurate and useful diagnostic technique to assess dialysis access function. The detection of conduit and anastomotic stenosis, measurement of volume flow, and assessment of hand perfusion for steal syndrome is possible. Duplex scanning can provide the necessary anatomic and hemodynamic information to identify clinically important abnormalities as well as plan a remedial endovascular or open surgical interventional procedure. Measurement of access volume flow is prognostic for durable dialysis and access patency, including determining if access maturation has occurred and when to intervene for a duplex-identified access stenosis. A duplex-measured volume flow of >800 mL/min can predict successful function of a dialysis access conduit. The application of duplex surveillance after autogenous vein or prosthetic bridge graft access construction has the potential to improve patency and function in the renal failure patient whose life is dependent on ongoing hemodialysis.