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NDT Advance Access originally published online on March 7, 2008
Nephrology Dialysis Transplantation 2008 23(6):1809-1815; doi:10.1093/ndt/gfn001
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemodialysis: review of the evidence

Martin Ferring1, John Henderson2, Antonius Wilmink3 and Steve Smith1

1 Department of Renal Medicine, Heartlands Hospital, Birmingham, UK 2 Department of Radiology, Heartlands Hospital, Birmingham, UK 3 Department of Vascular Surgery, Heartlands Hospital, Birmingham, UK

Correspondence and offprint requests to: Martin Ferring, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SU, UK. E-mail: martinferring@yahoo.co.uk

Keywords: arteriovenous fistula; chronic kidney disease; ultrasound; physical examination; pre-operative evaluation

The first 150 words of the full text of this article appear below.



   Introduction
 
The arteriovenous fistula (AVF) is the preferred access for haemodialysis [1]. However, AVF failure has become more common over the last three decades as more patients are older, and have diabetes or vascular disease. For radiocephalic AVF, a meta-analysis estimated modest primary (63%) and secondary (66%) patencies at 1 year [2].

AVF failures have been attributed to inadequate vessels used for surgery [3]. Pre-operative evaluation with ultrasound may select suitable vessels and reduce AVF failures [3].

We review the evidence for ultrasound evaluation for AVF formation. The following areas are addressed:

  • Ultrasound criteria for pre-operative evaluation
  • Pre-operative ultrasound findings and AVF outcomes
  • Comparison of pre-operative physical examination and ultrasound in terms of AVF outcomes.



   Methods
 
The published literature was searched on 29 October 2007 through Pubmed, Embase and the Cochrane library using the following keywords: (‘arteriovenous fistula’ or ‘vascular access’) and (‘kidney disease’ . . . [Full Text of this Article]



   Ultrasound criteria for pre-operative evaluation
 
Ultrasound equipment and technique
Arterial scan
Arterial diameter
Arterial wall morphology
Hyperaemic response
 Venous scan
Venous appearance and suitability for cannulation
Venous diameter and distensibility
Venous Doppler


   Pre-operative ultrasound findings and AVF outcomes
 
Definitions of AVF outcomes and their relevance to pre-operative assessment
Individual pre-operative ultrasound criteria and their relation to AVF outcome
Arterial criteria
Venous criteria
Pre-operative ultrasound use and AVF outcomes in patients at higher risk of AVF failure
Pre-operative ultrasound use and vascular access outcomes


   Comparison of pre-operative physical examination and ultrasound in terms of AVF outcomes
 


   Conclusions
 

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