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Color Doppler ultrasound and arteriovenous fistulas for hemodialysis

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Abstract

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.

Riassunto

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.

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Conflict of interest

Pasquale Zamboli, Fulvio Fiorini, Alessandro D’Amelio, Pasquale Fatuzzo, Antonio Granata declare that they have no conflict of interest.

Human and animal studies

The study described in this article did not include any procedures involving humans or animals.

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Authors and Affiliations

  1. Cattedra di Nefrologia, Seconda Università degli Studi di Napoli-Presidio Ospedaliero S.M.d.P. degli Incurabili di Napoli, Naples, Italy

    Pasquale Zamboli

  2. S.O.C. Nefrologia e Dialisi, Ospedale S.M. della Misericordia, Rovigo, Italy

    Fulvio Fiorini

  3. U.O.C. Nefrologia e Dialisi, AO Vito Fazzi, Lecce, Italy

    Alessandro D’Amelio

  4. Cattedra di Nefrologia, Scuola di Specializzazione in Nefrologia, AOU “Vittorio Emanuele-Policlinico”, Catania, Italy

    Pasquale Fatuzzo

  5. U.O.C. Nefrologia e Dialisi, Ospedale “San Giovanni di Dio”, Agrigento, Italy

    Antonio Granata

Authors
  1. Pasquale Zamboli
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  2. Fulvio Fiorini
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  3. Alessandro D’Amelio
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  4. Pasquale Fatuzzo
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  5. Antonio Granata
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Correspondence to Pasquale Zamboli.

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Zamboli, P., Fiorini, F., D’Amelio, A. et al. Color Doppler ultrasound and arteriovenous fistulas for hemodialysis. J Ultrasound 17, 253–263 (2014). https://doi.org/10.1007/s40477-014-0113-6

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  • DOI: https://doi.org/10.1007/s40477-014-0113-6

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