The clinical importance of color Doppler ultrasonography in puncture related complications of hemodialysis vascular access

Abstract

Background: The long-term survival of patients on hemodialysis (HD) is dependent on adequate HD which depends on quality and degree of functionality of vascular access. The aim of our study is to detect the role of color Doppler ultrasonography in evaluation of arteriovenous fistula (AVF). Materials and methods: Between January 2017 and October 2017, 60 patients had complicated AVF at Qena General Hospital & Qena University Hospital as primary and tertiary centers respectively with the same age group between 18 and 50 years old, had no diabetes mellitus were evaluated using color duplex-Doppler ultrasound (CDUS) after AVF maturation for detection of complications and comparison between primary and tertiary centers of its incidence. Results: The overall results revealed that 11 patients from 30 patients that had been referred to tertiary centers have complicated AVF (36.7%), and 19 patients had no shunt complication (63.3%). Twenty-two patients from 30 patients that had been referred to primary HD centers had complicated shunts. Thrombosis at tertiary centers represents 13.3%, stenosis 3.3% (1 patient), aneurysmal formation had 6.6% for (2 patients), hematoma 6.6%(2 patients), infection 3.3% (1 patient), venous hypertension 3.3% (1 patient), thrombosis and hematoma at primary centers 16.6% (5 patients for each), aneurysmal formation and infection 13.3% for each, and stenosis 10%. Conclusions: CDUS is a readily-available, non-invasive, risk-free, bedside technique that allows precise anatomic knowledge, qualitative, and quantitative data of the upper limb vascular system which greatly help in preoperative planning of AVF creation, assessment of prime time for puncture (maturation), early detection of complications, and choice of appropriate therapeutic procedure for their treatment.

Arteriovenous fistula access for dialysis using vessels of the arm

“…There has been a rising case of End stage renal disease (ESRD) in the subregion and thus the need to institute haemodialysis for patients' survival 1 . The performance of a successful haemodialysis session is hugely dependent on vascular access 2 .…”

“…The performance of a successful haemodialysis session is hugely dependent on vascular access 2 . A functional access site must have a good blood flow rate, be easily available, have great patency, minimal complications, support easy and withstand repeated cannulation 1,2 . Three main devices have been indicated for vascular access creation which includes arteriovenous fistula (AVF), arteriovenous graft (AVG) and dialysis catheter 3 .…”

“…AVF has been tagged the gold standard for maintaining vascular access to the body's circulation for haemodialysis 5 . Characteristics such as reduced complication rate, long-term usage, lower maintenance costs, lowered associated mortality, high durability, little or no interventions; have made AVF the best for vascular access, when compared to AVG and catheters 1,6,7 . However, the major challenges associated with the use of AVF are frequent primary failures and the long duration before maturation 7,8 .…”

“…The best maturation time for AVF remains a debatable discussion, although quick detection of dysfunctional AVFs, assessment for complications, and administration of indicated interventions, help to reduce AVF failure 9 . AVF failure could be early (primary) or late (secondary); while early (primary) failure occurs between the duration of AVF creation and first 3 months before usage, late (secondary) AVF failure occurs after 3 months of its creation and when it has started being used for haemodialysis 1 . Furthermore, after the failure of the primary AVF, a secondary fistula could be created by converting an arterial outflow vein to a direct or transposed AVF 10 .…”