The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

Saati, Ammar; Puffenberger, Debra; Kirksey, Levester; Fendrikova-Mahlay, Natalia

doi:10.21037/cdt-22-129

Cardiovasc Diagn Ther

2023

DOI: 10.21037/cdt-22-129

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The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

Ammar Saati¹,

Debra Puffenberger²,

Levester Kirksey³

et al.

Abstract: The rise in prevalence of end stage renal disease (ESRD) and the impact on health care resulted in increasing focus on delivery of vascular access. Hemodialysis vascular access is the most common renal replacement therapy method. The vascular access types include arteriovenous fistula, arteriovenous graft, and tunneled central venous catheters. Vascular access function remains an important outcome measure with significant impact on morbidity and health care cost. The survival and quality of life of patients on… Show more

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Cited by 3 publications

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“…A paper by Li et al ( 7 ) provides an overview of the novel technique of endovascular arteriovenous fistula creation in selected patients with suitable vascular anatomy. Saati and colleagues ( 8 ) discuss the role of duplex ultrasound in noninvasive vascular access surveillance. In their paper, Gonzalez et al ( 9 ) focus on multimodality imaging of arteriovenous fistula and grafts in patients with end-stage renal disease.…”

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Endovascular and surgical interventions in the end-stage renal disease population

Partovi¹,

Kirksey²

2023

Cardiovasc Diagn Ther

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Patients with end-stage renal disease require renal replacement therapy, which is most frequently performed via hemodialysis.To perform hemodialysis, a dialysis catheter or arteriovenous fistula or graft is needed as a means of vascular access. Once this initial surgical vascular access has been created, access maintenance can be performed using endovascular techniques. This special series encompasses a comprehensive multidisciplinary overview of advancements in these endovascular and surgical interventions in the end-stage renal disease population. It also sheds light on evolving technologies, such as endovascular arteriovenous fistula creation and the current evidence for the use of drug-coated balloons in vascular access maintenance.In their paper, Walker and Gadegbeku (1) emphasize the urgency of addressing health disparities in the end-stage renal disease population based on national guidelines. Richarz and colleagues (2) describe the preoperative imaging workup for vascular access creation and propose the use of advanced modalities as problem-solving tools for specific clinical questions. The paper by Ruff et al. (3) addresses the medical and endovascular management of atherosclerotic disease in the end-stage renal disease population. Montelongo and colleagues (4) outline various surgical creation techniques for upper extremity vascular access, whereas Alnahhal, Williams, and Kirksey (5) focus on surgical creation of lower extremity vascular access in patients with supradiaphragmatic central venous occlusion. Alnahhal, Rowse, and Kirksey (6) address the best approach for obtaining vascular access in clinical challenging cases. A paper by Li et al. (7) provides an overview of the novel technique of endovascular arteriovenous fistula creation in selected patients with suitable vascular anatomy. Saati and colleagues (8) discuss the role of duplex ultrasound in noninvasive vascular access surveillance. In their paper, Gonzalez et al. (9) focus on multimodality imaging of arteriovenous fistula and grafts in patients with end-stage renal disease. DePietro and Trerotola discuss the role of plain balloon angioplasty (10) and drug-coated balloon angioplasty (11) for vascular access maintenance in the end-stage renal disease population. In his paper, McLennan (12) describes stenting approaches for dialysis access maintenance. Wu, Kalva, and Cui (13) describe thrombectomy techniques used for the endovascular treatment of thrombosed vascular access, as well as the potential complications of these methods. A paper by Sharma et al. (14) discusses the role of tunneled dialysis catheters in the initiation of hemodialysis, including an overview of atypical infradiaphragmatic access site options for catheter placement. Two articles in this series address the challenge of central venous stenotic and occlusive disease in patients with chronic kidney disease. First, a paper by Alnahhal, Rowse, and Kirksey (15) provides an overview of management options for central venous disease. Second, an article by Rashwan and colleagues (1...

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confidence: 99%

Endovascular and surgical interventions in the end-stage renal disease population

Partovi¹,

Kirksey²

2023

Cardiovasc Diagn Ther

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Integrating vascular access surveillance with clinical monitoring for stenosis prediction

Wu,

Lin

2023

J Nephrol

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Barriers and facilitators to vascular access point‐of‐care ultrasound in haemodialysis: An international survey of haemodialysis clinicians

Schoch,

Fielding,

Marticorena

et al. 2024

Journal of Renal Care

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BackgroundUtilising point‐of‐care ultrasound for assessment and cannulation of vascular access in people receiving haemodialysis has shown positive clinical results. Nonetheless, there is variation in how renal health care professionals worldwide embrace this method, and there's a lack of research on the factors that promote or hinder its adoption.ObjectivesTo explore regional differences, and barriers and facilitators, to the use of point‐of‐care ultrasound for assessment and cannulation of vascular access in haemodialysis.DesignExploratory descriptive cross‐sectional web‐based survey.ParticipantsHealthcare clinicians working in haemodialysis responsible for cannulation of arteriovenous fistula or grafts.ResultsThe survey was completed by 645 health care clinicians from 38 countries. 75% to 93% of respondents from Australia/New Zealand, Canada, Europe and United Kingdom/Ireland reported access to ultrasound, compared to 26% (n = 43/167) from the United States respondent's reported lower levels of ultrasound training than other regions. Facilitators for using ultrasound were: the availability of ultrasound training (87%, n = 558), to reduce miscannulations (76%, n = 255/336) and to improve patient outcomes (73%, n = 246/336). Point‐of‐care ultrasound barriers were lack of access to ultrasound education (82%, n = 196/239), lack of ultrasound machines (33%, n = 212/645) or believing that ultrasound was someone else's role (38%, n = 29/86).ConclusionsThis study revealed national and regional differences related to haemodialysis point‐of‐care ultrasound. Understanding the regions requiring more education and implementation of ultrasound and what motivates staff, or deters from using ultrasound, is crucial for effectiveness of future implementation and workplace change initiatives.

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The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

Cited by 3 publications

References 25 publications

Endovascular and surgical interventions in the end-stage renal disease population

Endovascular and surgical interventions in the end-stage renal disease population

Integrating vascular access surveillance with clinical monitoring for stenosis prediction

Barriers and facilitators to vascular access point‐of‐care ultrasound in haemodialysis: An international survey of haemodialysis clinicians

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