Role of Doppler Ultrasonography in Surveillance of Vascular Access and Assessment of the Shunt in Hemodialysis Patients

Abstract

Chronic renal failure is considered as worldwide healthproblem, with increasing incidence and prevalence, high costs and poor outcomes. Before the emergence of renal replacement therapy, renal failure was considered a main cause of death. Renal replacement therapy made it possible to be treated; either byrenal transplantation, hemodialysis and peritoneal dialysis. Maintaining permanent hemodialysis vascular access is anoverwhelming problem that has been traditionally considered the major obstacle in dialysis patients. Patients with acute kidney failure (AKF) and chronic kidney failure (CKF) require an appropriate vascular access for hemodialysis which may be temporary or permanentas (AV shunt, AV fistula, AVgraft and tunneled and non tunneledhemodialysis catheter ). AV fistulawhich is themost appropriate type,is surgically created subcutaneous anastomosis between an artery and a veinmostly between radial artery and cephalic vein, in case of inadequate blood vessels we use arteriovenous graft mostly between brachial artery and axillary vein, in case of chronic heart failure syndrome and inadequate peripheral blood vessels doctors use Chronic tunneledcentral venous catheter, but its complications are more frequent. The aim of this study is to evaluate the role and usefulness of Doppler sonography in planning hemodialysisAVF via assessment of the suitability of the arteries and veins of the upper limb and prediction of hemodialysis fistula success before surgery and assessment of maturation and possible dysfunction and complications of already formed native hemodialysisarterio-venous fistula. Preoperative Doppler ultrasound provides a road map for the future design of created hemodialysis AVF with prediction of its outcome and alteration of surgical decision. Postoperative Doppler ultrasound describes the fistula related complications e.g. stenosis, thrombosis, infection, aneurysms and pseudoaneurysm, venous hypertension and fistula dysfunction and so, it can prolong access longevity and decrease the cost of haemodialysis access management. In order to minimize morbidity and cost, an effort should be directed at the goal that all patients starting haemodialysis treatment have a vascular access ready to be punctured.