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Hemodialysis Stenosis/Occlusion
Anjuli Cherukuri, MD; Shweta Bhatt, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Hemodialysis (HD)
            • Arteriovenous fistula (AVF)
          • Synonyms

            • AVF stenosis/occlusion
            • Fistula stenosis/occlusion
          • Definitions

            • AVF is created when anastomosis is made between artery and vein allowing vein to enlarge and arterialize to become accessible and provide adequate flow for HD; most commonly in arms but can be in thigh
            • HD graft is artificial graft made of polytetrafluoroethylene (PTFE) that connects artery to vein in similar manner as AVF but takes less time to mature
            • Common AVFs: Radiocephalic, brachiocephalic, brachiobasilic (usually requires 2 surgeries)
            • Common HD grafts: Forearm loop, upper arm, and thigh

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • CT Findings

                • Angiographic Findings

                  • Imaging Recommendations

                    PATHOLOGY

                    • Causes of AVF Thrombosis

                      • Causes of AVF Stenosis

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. Wo K et al: Developing duplex ultrasound criteria for diagnosis of arteriovenous fistula stenosis. Ann Vasc Surg. 38:99-104, 2017
                                    2. National Kidney Foundation: KDOQI clinical practice guideline for hemodialysis adequacy: 2015 Update. Am J Kidney Dis. 66(5):884-930, 2015
                                    3. Quencer KB et al: Arteriovenous fistulas and their characteristic sites of stenosis. AJR Am J Roentgenol. 205(4):726-34, 2015
                                    4. Santoro D et al: Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis. 7:281-94, 2014
                                    5. Vardza Raju A et al: Reliability of ultrasound duplex for detection of hemodynamically significant stenosis in hemodialysis access. Ann Vasc Dis. 6(1):57-61, 2013
                                    6. Chen MC et al: Arteriovenous fistula and graft evaluation in hemodialysis patients using MDCT: a primer. AJR Am J Roentgenol. 194(3):838-47, 2010
                                    7. Wiese P et al: Colour Doppler ultrasound in dialysis access. Nephrol Dial Transplant. 19(8):1956-63, 2004
                                    8. Finlay DE et al: Duplex and color Doppler sonography of hemodialysis arteriovenous fistulas and grafts. Radiographics. 13(5):983-9, 1993
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Hemodialysis (HD)
                                              • Arteriovenous fistula (AVF)
                                            • Synonyms

                                              • AVF stenosis/occlusion
                                              • Fistula stenosis/occlusion
                                            • Definitions

                                              • AVF is created when anastomosis is made between artery and vein allowing vein to enlarge and arterialize to become accessible and provide adequate flow for HD; most commonly in arms but can be in thigh
                                              • HD graft is artificial graft made of polytetrafluoroethylene (PTFE) that connects artery to vein in similar manner as AVF but takes less time to mature
                                              • Common AVFs: Radiocephalic, brachiocephalic, brachiobasilic (usually requires 2 surgeries)
                                              • Common HD grafts: Forearm loop, upper arm, and thigh

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • CT Findings

                                                  • Angiographic Findings

                                                    • Imaging Recommendations

                                                      PATHOLOGY

                                                      • Causes of AVF Thrombosis

                                                        • Causes of AVF Stenosis

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Wo K et al: Developing duplex ultrasound criteria for diagnosis of arteriovenous fistula stenosis. Ann Vasc Surg. 38:99-104, 2017
                                                                      2. National Kidney Foundation: KDOQI clinical practice guideline for hemodialysis adequacy: 2015 Update. Am J Kidney Dis. 66(5):884-930, 2015
                                                                      3. Quencer KB et al: Arteriovenous fistulas and their characteristic sites of stenosis. AJR Am J Roentgenol. 205(4):726-34, 2015
                                                                      4. Santoro D et al: Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis. 7:281-94, 2014
                                                                      5. Vardza Raju A et al: Reliability of ultrasound duplex for detection of hemodynamically significant stenosis in hemodialysis access. Ann Vasc Dis. 6(1):57-61, 2013
                                                                      6. Chen MC et al: Arteriovenous fistula and graft evaluation in hemodialysis patients using MDCT: a primer. AJR Am J Roentgenol. 194(3):838-47, 2010
                                                                      7. Wiese P et al: Colour Doppler ultrasound in dialysis access. Nephrol Dial Transplant. 19(8):1956-63, 2004
                                                                      8. Finlay DE et al: Duplex and color Doppler sonography of hemodialysis arteriovenous fistulas and grafts. Radiographics. 13(5):983-9, 1993