Semin intervent Radiol 2022; 39(01): 009-013
DOI: 10.1055/s-0041-1740946
Review Article

Clinical Aspects of Dialysis Interventions: Physical and Sonographic Findings

Vandana Dua Niyyar*
1   Division of Nephrology, Emory University School of Medicine, Atlanta, Georgia
,
Anil K. Agarwal*
2   Department of Medicine, VA Central California Health Care System, Fresno, California
,
Loay H. Salman
3   Division of Nephrology and Hypertension, Albany Medical College, Albany, New York
› Author Affiliations

Abstract

Physical examination (PE) of arteriovenous access remains of high clinical value and continues to be recommended by leading societies and guidelines. PE is easy to learn and perform. Once learned, examiners can provide a comprehensive arteriovenous (AV) access examination in 20 to 30 seconds. Therefore, we continue to advocate that AV access PE should be part of the training for all dialysis care providers. Similarly, ultrasound can provide important AV access evaluation and provide key information. It is relatively cheap and can be readily available at the bed side. Additionally, it is well accepted by patients, as it is not expected to be associated with pain or discomfort during the examination. We present in this review the key components of PE, signs and symptoms of AV access dysfunction, and the role of ultrasound in AV access evaluation as a complementary tool to PE.

* Both authors contributed equally to this article.




Publication History

Article published online:
18 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Kolff WJ. Dialysis in treatment of uremia: artificial kidney and peritoneal lavage. AMA Arch Intern Med 1954; 94 (01) 142-160
  • 2 Alwall N, Norvitt L, Steins AM. On the artificial kidney; some experiences during the study of dialytic treatment on animals with uremia caused by mercuric chloride poisoning. Acta Med Scand 1949; 132 (05) 477-486
  • 3 Scribner BH, Buri R, Caner JE, Hegstrom R, Burnell JM. The treatment of chronic uremia by means of intermittent hemodialysis: a preliminary report. Trans Am Soc Artif Intern Organs 1960; 6: 114-122
  • 4 Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275 (20) 1089-1092
  • 5 Baker Jr LD, Johnson JM, Goldfarb D. Expanded polytetrafluoroethylene (PTFE) subcutaneous arteriovenous conduit: an improved vascular access for chronic hemodialysis. Trans Am Soc Artif Intern Organs 1976; 22: 382-387
  • 6 Depner TA. Techniques for prospective detection of venous stenosis. Adv Ren Replace Ther 1994; 1 (02) 119-130
  • 7 Schwab SJ, Raymond JR, Saeed M, Newman GE, Dennis PA, Bollinger RR. Prevention of hemodialysis fistula thrombosis. Early detection of venous stenoses. Kidney Int 1989; 36 (04) 707-711
  • 8 Salman L, Beathard G. Interventional nephrology: physical examination as a tool for surveillance for the hemodialysis arteriovenous access. Clin J Am Soc Nephrol 2013; 8 (07) 1220-1227
  • 9 Asif A, Gadalean FN, Merrill D. et al. Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study. Kidney Int 2005; 67 (05) 1986-1992
  • 10 Agarwal R, McDougal G. Buzz in the axilla: a new physical sign in hemodialysis forearm graft evaluation. Am J Kidney Dis 2001; 38 (04) 853-857
  • 11 Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist?. Semin Dial 2008; 21 (06) 557-560
  • 12 Haddad NJ, Winoto J, Shidham G, Agarwal AK. Hemodialysis access monitoring and surveillance, how and why?. Front Biosci (Elite Ed) 2012; 4: 2396-2401
  • 13 Robbin ML, Chamberlain NE, Lockhart ME. et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 2002; 225 (01) 59-64
  • 14 Robbin ML, Greene T, Allon M. et al; Hemodialysis Fistula Maturation Study Group. Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements: findings from the Hemodialysis Fistula Maturation Study. J Am Soc Nephrol 2018; 29 (11) 2735-2744
  • 15 Lockhart ME, Robbin ML. Hemodialysis access ultrasound. Ultrasound Q 2001; 17 (03) 157-167
  • 16 Niyyar VD. Ultrasound in dialysis access: opportunities and challenges. J Vasc Access 2020; 21 (03) 272-280
  • 17 Teodorescu V, Gustavson S, Schanzer H. Duplex ultrasound evaluation of hemodialysis access: a detailed protocol. Int J Nephrol 2012; 2012: 508956
  • 18 Napoli M, Montinaro A, Russo F. et al. Early experiences of intraoperative ultrasound guided angioplasty of the arterial stenosis during upper limb arteriovenous fistula creation. J Vasc Access 2007; 8 (02) 97-102
  • 19 Ascher E, Hingorani A, Marks N. Duplex-guided balloon angioplasty of failing or nonmaturing arterio-venous fistulae for hemodialysis: a new office-based procedure. J Vasc Surg 2009; 50 (03) 594-599
  • 20 Gorin DR, Perrino L, Potter DM, Ali TZ. Ultrasound-guided angioplasty of autogenous arteriovenous fistulas in the office setting. J Vasc Surg 2012; 55 (06) 1701-1705
  • 21 Kumar S, Mahajan N, Patil SS. et al. Ultrasound-guided angioplasty for treatment of peripheral stenosis of arteriovenous fistula - a single-center experience. J Vasc Access 2017; 18 (01) 52-56
  • 22 Cho S, Lee YJ, Kim SR. Clinical experience with ultrasound guided angioplasty for vascular access. Kidney Res Clin Pract 2017; 36 (01) 79-85
  • 23 Bojakowski K, Góra R, Szewczyk D, Andziak P. Ultrasound-guided angioplasty of dialysis fistula - technique description. Pol J Radiol 2013; 78 (04) 56-61
  • 24 Cui J, Freed R, Liu F, Irani Z. Interrupting rivaling access-flow with nonsurgical image-guided ligation: the “IRANI” procedure. Semin Dial 2015; 28 (06) E53-E57
  • 25 Ross JR, Franga DL, Gallichio M, Patel AJ, Ouriel K. Role of intravascular ultrasound imaging during endovascular interventions of failing hemodialysis access grafts. J Vasc Surg 2017; 65 (05) 1383-1389
  • 26 García-Medina J, García-Alfonso JJ. Ultrasound-guided angioplasty of dysfunctional vascular access for haemodialysis. The pros and cons. Cardiovasc Intervent Radiol 2017; 40 (05) 750-754