The role of sonography in the planning of arteriovenous fistulas for hemodialysis

Patients presenting for initial access evaluation in contemporary practice are less likely to have arteries and veins suitable for native fistula (AVF) formation in the classic location. Physical examination of the upper extremity alone may be inadequate for selection of arteries and veins that will mature into a functioning AF. The purpose of this paper is to determine how duplex ultrasonography can be used as an effective modality for the preoperative evaluation of vessels before construction of arteriovenous fistula for hemodialysis. The author have used duplex ultrasound (DU) to assess upper-extremity vasculature for planning of dialysis access procedures. Criteria for selection of arteries and veins and a detailed description of DU examination protocol are reviewed. Routine use of upper-extremity DU has identified many patients with veins that are suitable for use and determined arteries with optimal arterial inflow for successful AFV creation.