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International Journal of Nephrology
Volume 2012, Article ID 508956, 7 pages
Review Article

Duplex Ultrasound Evaluation of Hemodialysis Access: A Detailed Protocol

1Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA
2The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029, USA

Received 17 January 2012; Revised 4 April 2012; Accepted 19 June 2012

Academic Editor: Franca Anglani

Copyright © 2012 Victoria Teodorescu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Supplementary Material

Information gained through duplex ultrasound evaluation should be relayed in a comprehensive, but succinct, fashion. The Vascular Access Diagram is representative of the detailed information that is reported by the interpreting physician. Generally, a complete examination includes examination of the inflow artery, the access itself and outflow veins. PSVs through the inflow artery and at the anastamosis are documented as well as any abnormalities identified by B-mode evaluation. In this example, PSVs are markedly elevated at the radio-cephalic anastamosis in comparison to those seen in the proximal artery, leading to the diagnosis of stenosis. The artery was seen to be heavily calcified. Similar notations are made of the access itself. In addition, measurements along the fistula are reported. Volume flow at a representative site can then be calculated. The deep veins of the neck and shoulder are assessed for their adequacy to provide outflow. In this example, old deep vein thrombosis was seen in the internal jugular vein, but the true outflow veins, axillary, subclavian and innominate, are patent. The cause of maturation failure for this particular access is likely arterial disease, information which assists in planning for what to do next. As visual information may be more easily processed, a diagram is provided.

  1. Supplementary Figure