Doppler Ultrasound: A Powerful Tool for Vascular Access Surveillance

Abstract

National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines recommend Doppler ultrasound (DU) for surveillance of vascular access (VA), but trials have not been unanimous about its benefit on VA patency. The aim of this study was to evaluate the accuracy of DU for patency, as well as to highlight additional data provided by this method. A transversal study was conducted to evaluate DU method in correlation with BTM using paired t-test and Pearson test. Ultrasonography evaluation was performed with a Siemens Acuson X150 Ultrasound device and BTM-Qa with the Blood Temperature Monitor BTM(®). Access blood flow (Qa) values were correlated with several factors by nonparametric tests. Fifty hemodialysis patients were included, with mean age of 64.5 ± 13.7 years; durations of hemodialysis and VA were 51.4 ± 47.3 and 47.6 ± 42.1 months, respectively. The mean difference between DU and BTM flows was 20.5 ml/minute (p 0.624). Pearson correlation was 0.851 (p < 0.001). DU-Qa values varied significantly with several factors: type of VA, reason for DU referral, the presence of artery stenosis, and the location and number of stenosis. BTM-Qa values only varied significantly with the presence and number of stenosis. Various silent abnormalities were detected with DU. DU provides accurate anatomic and hemodynamic data to further knowledge regarding the etiology of stenosis and other abnormalities that compromise VA well functioning.

Clinical experience with ultrasound guided angioplasty for vascular access

“…For evaluating dysfunctional access, the first and most cost-effective method is physical examination [ 10 – 13 ]. Ultrasonography confirms the physical examination results such as inflow stenosis, outflow stenosis, or simply deep-seated vein and provides important information about the functional severity such as brachial artery flow rates [ 14 – 17 ]. The ultrasound findings with physical examination determine the treatment methods, such as angioplasty, revision surgery or conservative management.…”

Application of ultrasonography in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients

“…[ 11 ] Color Doppler ultrasound is used widely in clinic [ 12 – 15 ] and is recommended as the best way to monitor AVF due to its noninvasiveness, no radioactive damage, repeated usage, low price, and real-time access to AVF anatomical and hemodynamic information. [ 16 , 17 ] The brachial artery is straighter with larger diameter and the blood flow is more accurately measured by Doppler ultrasound. Thus, the brachial artery is considered as the best measurement site for ultrasound monitoring of AVF.…”

Value of Doppler evaluation of physically abnormal fistula: hemodynamic guidelines and access outcomes

“…Regular surveillance with ultrasound (USG) in addition to physical examination (PE) offers no additional benefits [4]. Nevertheless, USG has numerous effects on VA care including surveillance [5-7].…”