Edenberg Jan, Benschop Pim, Høgåsen Kolbjørn
Radiologisk avdeling, Sykehuset Innlandet Lillehammer, 2629 Lillehammer, Norway.
Tidsskr Nor Laegeforen. 2009 Aug 27;129(16):1635-8. doi: 10.4045/tidsskr.09.34272.
Permanent and reliable vascular access is of utmost importance for patients (with chronic renal failure) in need of haemodialysis. Autogenous arteriovenous fistula (AVF) on the forearm are robust and have the benefits of providing long-term access with relatively few complications. The main problem is insufficient blood flow due to stenoses requiring early intervention. The AVF therefore needs surveillance with regular clinical examination supplemented with imaging. In recent years Doppler sonography has gained an increasingly important role in the assessment of AVFs. This paper discusses AVFs and frequent complications and stresses the benefit of Doppler sonography in the planning and surveillance of AVFs.
The survey is based on literature retrieved from a PubMed search, and our experience from sonographic examinations of AVFs in the Central Hospital of Lillehammer, Norway.
Doppler sonography is a non-invasive imaging modality without discomfort for the patient, and well suited for examination of AVFs. The method has a high sensitivity for detection of stenoses and other AVF-related problems, and can provide a detailed image of the course and diameter of blood vessels, with quantitative measurement of blood flow. Indications for Doppler sonography are preoperative mapping, assessment of fistula problems and maturity; it is also a useful method for continuous surveillance of fistulas.
Doppler sonography can be used for immediate treatment of patients with sudden AVF problems; and if necessary endovascular intervention or surgery can follow. Recent European guidelines recommend the method as a standard procedure before and after creation of an AVF. Doppler sonography should have a central position in a multidisciplinary teamwork on surveillance of patients with AVFs in need of haemodialysis.
