Duplex ultrasound is a useful non-invasive tool for evaluating vascular access in hemodialysis patients. It can assess vessel morphology and blood flow. Preoperative evaluation of veins and arteries using ultrasound identifies criteria for successful vascular access placement, such as a minimum vein diameter of 2.5 mm and artery diameter of 2.0 mm. Ultrasound is also used to detect vascular access complications like stenosis, thrombosis, aneurysms, and steal syndrome. Color Doppler characteristics help identify hemodynamically significant stenoses and assess their severity.
Duplex ultrasound is a useful non-invasive tool for evaluating vascular access in hemodialysis patients. It can assess vessel morphology and blood flow. Preoperative evaluation of veins and arteries using ultrasound identifies criteria for successful vascular access placement, such as a minimum vein diameter of 2.5 mm and artery diameter of 2.0 mm. Ultrasound is also used to detect vascular access complications like stenosis, thrombosis, aneurysms, and steal syndrome. Color Doppler characteristics help identify hemodynamically significant stenoses and assess their severity.
Duplex ultrasound is a useful non-invasive tool for evaluating vascular access in hemodialysis patients. It can assess vessel morphology and blood flow. Preoperative evaluation of veins and arteries using ultrasound identifies criteria for successful vascular access placement, such as a minimum vein diameter of 2.5 mm and artery diameter of 2.0 mm. Ultrasound is also used to detect vascular access complications like stenosis, thrombosis, aneurysms, and steal syndrome. Color Doppler characteristics help identify hemodynamically significant stenoses and assess their severity.
Duplex ultrasound is a useful non-invasive tool for evaluating vascular access in hemodialysis patients. It can assess vessel morphology and blood flow. Preoperative evaluation of veins and arteries using ultrasound identifies criteria for successful vascular access placement, such as a minimum vein diameter of 2.5 mm and artery diameter of 2.0 mm. Ultrasound is also used to detect vascular access complications like stenosis, thrombosis, aneurysms, and steal syndrome. Color Doppler characteristics help identify hemodynamically significant stenoses and assess their severity.
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Dr. FARSANA.
TK JUNIOR RESIDENT Colour Doppler ultrasound in dialysis access DOQI guidelines -creation of a primary AVF is possible in only 50% of the patient.
synthetic polytetrafluoroethylene (PTFE)
grafts - predominant form of permanent vascular acces. Angiography - gold standard for imaging of vascular access abnormalities.
duplex ultrasound-
itprovides information both on the morphology
and on the function of vascular access. non-invasive bedside procedure with lower costs and with no need for radio contrast. PREOPERATIVE VASCULAR EVALUATION Clinical criteria for the selection of veins and arteries for the successful placement of an AVF :-
visible cephalic vein after tourniquet
placement a superficial course of the vein absence of tortuous veins an easily palpable radial pulse a patent palmar arch (Allen’s test) absence of significant pressure differences (20 mmHg) between both arms . SONOGRAPHIC CRITERIA FOR THE EXAMINATION OF VEINS BEFORE PLACEMENT OF A VASCULAR ACCESS.
Using a tourniquet, a venous luminal
diameter of >2.5 mm is required for placement of an AVF and a diameter of >4.0 mm for grafts. absence of segmental stenoses or occluded segments. continuity with the deep venous system in the ipsilateral upper arm. without the use of a tourniquet:
a minimal diameter of the cephalic vein of
>2.0 mm . ARTERY arterial diameter>2.0 mm peak systolic velocity of at least 50 cm/s
significantly increased risk of AVF failure
when the internal diameter of the radial artery was <1.6 mm. Initial diameter and arterial compliance affect access outcome. The distensibility of the arterial wall can be assessed preoperatively by evaluating the Doppler waveform in the radial artery during reactive hyperaemia, induced by reopening a fist that was clenched for 2 min. The high-resistance triphasic wave form with clenched fist changes to a low- resistance biphasic waveform after releasing the fist .
IMG 1 resistance index (RI)
peak systolic flow velocity-end diastolic flow
velocity) /peak systolic flow velocity A preoperative RI of >0.7 in the feeding artery after release of the fist indicates that arterial blood flow will not increase sufficiently so that the chance of successful creation of an AVF is reduced. TABLE evaluation of access flow
diameter of the feeding artery is determined by
B-mode Ultrasonography in a transverse plane from inner edge to inner edge. The cross-sectional area is calculated by equipment software. At the same site Doppler spectra for calculation of time averaged velocity (TAV) are obtained in a longitudinal plane with an insonating angle maintained at < 60. The sample volume size must be sufficiently large to include the entire luminal cross section (Figure 2). In PTFE grafts, sonographically determined threshold access flow rates less than 500–800 ml/min are associated with a significantly increased risk of failure.
Luminal diameter reduction >50% Peak systolic flow velocity >400 cm/s Pronounced aliasing phenomenon Indirect characteristics at the feeding brachial artery High resistance Doppler waveform Reduction in access flow volume VASCULAR ACCESS STENOSIS
Graft stenosis usually develop in the venous
outflow tract at the site of anastomosis between the graft and the vein.
This is the result of intimal and
fibromuscular hyperplasia, caused by shear stress. The frictional force generated by blood flow at sites of changing luminal diameter, e.g. at the site of graft anastomosis, can be estimated by the aliasing phenomenon seen in CDU. PIC 3 For calculation of stenosis, the minimal intraluminal cross-sectional area is compared with the diameter of a nearby normal segment usin g the formula THROMBOSIS AND ANEURYSM FORMATION IN VASCULAR ACCESS
Thrombosis- most common cause of vascular
access failure . PTFE grafts-thrombosis is primarily the result of progressive venous outflow stenosis. AVFs -occur early because of inadequate flow resulting from small lumen of vessels or failure to dilate. Aneurysms and pseudoaneurysms develop at sites of vessel destruction after repeated cannulation. Colour Doppler - ‘to-and-fro’ sign, a typical waveform characterized by the backflow of blood from the aneurysmatic sac into the original vessel lumen during diastole. FIG 4 Steal syndrome
Elderly patients Patients with co-morbid conditions (diabetes, vascular disease) in end-stage renal disease. Because of low resistance in the venous outflow, the fistula sucks not only the antegrade flow into the feeding artery but also ‘steals’retrograde flow from the hand via the palmar arch and jeopardizes adequate perfusion of the hand. STEALSYNDROME – when compensatory mechanisms to maintain peripheral arterial perfusion fail. Risk factors female gender age >60 years diabetes mellitus The steal syndrome C/F pain at rest pain during haemodialysis sessions, ulcerations, mostly acral necrosis and even tissue loss. IMG THANK YOU…..
