Upper limb anatomy and preoperative mapping

Abstract

Vascular access is absolutely essential for haemodialysis due to its relationship with quality of dialysis and associated morbidity. Therefore, it must be monitored and continuously surveilled from the moment it is created to prevent failure in maturation and thrombosis. Multidisciplinary collaboration is necessary when the main aim is to achieve the adequate vascular access flow with the fewest possible complications. The starting point, and probably the main one, is vascular access planning. This planning requires both a deep understanding of the anatomy of the upper limb and enough skill to examine it by Doppler ultrasound. The aim of this article is to review the anatomical and haemodynamical concepts of the arterial and venous vascular tree and explain how to perform ultrasound mapping, optimising the technical resources provided by this tool. Likewise, adequate access creation criteria that minimise the risk of failure and associated complications will be discussed.

Chinese expert consensus on transradial access in percutaneous peripheral interventions

“…In addition, some anatomical variations, including high radial artery bifurcation or arterial loops, should be assessed during the procedure. 30 The choice of catheter and left or right TRA can be made based on the aortic arch classification and variation in the origin of the subclavian artery. The left radial artery access has a shorter distance to the visceral vessels and does not require passing through the brachiocephalic trunk compared to the right radial artery access.…”

Multiparametric ultrasound for upper extremity dialysis access evaluation

“…This evaluation should include a physical examination and color Doppler US, as well as computed tomography, magnetic resonance imaging, or digital subtraction angiography, as clinically warranted. In combination with the patient’s history and physical exam, these examinations should allow clinicians to perform an adequate evaluation of the anatomical and functional features of the vasculature to determine which patients are suitable candidates for surgical AVF or AVG creation [ 1 , 4 ].…”

The Role of Ultrasound Examination in the Assessment of Suitability of Calcified Arteries for Vascular Access Creation—Mini Review

“…When severe calcifications are present, significant proximal stenosis should be excluded. Experts recommend that the entire arterial system of the upper limb is screened in a longitudinal view using a color Doppler ultrasound to detect sites of increased velocities and possible stenosis [ 32 ]. Not only is this time consuming, but it often cannot be performed in severely calcified arteries as the Doppler signal penetration is often poor and drop outs are present, limiting its use at the very sites where it would be most needed [ 26 ].…”

“…On the other hand, we also did not detect a difference in PSV in patients with successful AVF creation vs. primary failure in a very small group of patients with calcified arteries of an adequate diameter (>2 mm) [ 27 ]. Because PSV is influenced by arterial stiffness and calcification, it cannot be considered a reliable factor for fistula prognosis [ 32 , 39 ] and its role in predicting AVF maturation in borderline cases, e.g., small or calcified arteries, remains to be established.…”

“…In a pulsed-wave Doppler mode, the shape of the signal obtained should be evaluated. Downstream of a hemodynamically significant stenosis, a poststenotic Doppler pattern is seen with a flattened morphology that loses its typical triphasic shape and becomes monophasic, with parvus (low PSV, low RI) and tardus (slow acceleration (low Acc max ), long acceleration time (AT)) features [ 32 , 40 ]. PSV is reduced as a result of the flow obstruction caused by stenosis, and EDV is increased as a result of peripheral vasodilatation caused by ischemia, resulting in a reduced RI.…”