Venous angiography and the surgical management of subcutaneous hemodialysis fistulas.

Venous angiography of subcutaneous arteriovenous (A-V)) hemodialysis fistulas involves venous injection of radiographic contrast material which spreads throughout the venous system and into the arteries via the A-V anastomosis when blood flow to the extremity is temporarily occluded. Direct arterial cannulation is avoided. Subsequent restoration of blood flow with rapid sequential roentgenograms differentiates arteries from veins and identifies direction of fistula blood flow. A 44 month experience with 125 consecutive studies in 82 patients was performed with a 0.8% complication rate. Indications for fistulography included insufficient blood flow during dialysis (67%), cardiac failure (10%), aneurysms (6%), sepsis of undertermined site (6%) and other (77%). Roentgenographic findings identified vascular stenoses or occlusions (45%), malpositioned dialysis needles (11%), aneurysms (9%), unsuitable veins for dialysis (6%), absence of septic origin (5%), abnormal flow rates or patterns (5%), technically unsuitable studies (2%) and normal or baseline studies (17%). Information useful in planning clinical management of the patient was obtained in 88% of studies and fistular operations were performed in 65 patients (52%). Venous fistulography can be an effective and safe method of evaluating and planning correction of A-V dialysis fistula complications.