Introduction: Ultrasound and colorDoppler technique, which is relatively inexpensive, rapid, non-invasive and repeatable is a powerful tool used for early diagnosis of vascular access (VA) complications in hemodialysis patients. To date a standard and widely comprehensible echocolorDoppler (ECD) protocol is not available. Materials and Methods: A simple step-by-step protocol based on anatomical and hemodynamic parameters of VA has been developed during a 3-years VA ECD follow-up. It consists of an ECD study scheme. The algorithm created involves the calculation of brachial artery flow, description of artero-venous and/or graft-vascular anastomosis and efferent vessel and/or graft. Results: The algorithm allows to formulate a medical report that takes into account both anatomic and hemodynamic parameters of the VA. Reduction of complications and the prevention of chronic complications as well as the early detection of acute problems were achieved. Discussion and Conclusion: The creation of a step-by-step protocol may simplify the multidisciplinary management of VA, its monitoring and the early diagnosis of its complications.

Keywords:
Vascular access, Ultrasound, EchocolorDoppler, Artero-venous fistula, Graft, Hemodialysis
1.
Lambie SH, Taal MW, Fluck RJ, McIntyre CW: Analysis of factors associated with variability in haemodialysis adequacy. Nephrol Dial Transplant 2004; 19: 406–412.
2.
Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Amado L, Sameiro-Faria M, Miranda V, Vieira M, Santos-Silva A, Costa E: Type of vascular access and location in online hemodiafiltration and its association with patient’s perception of health-related quality of life. J Vasc Access 2014; 15: 175–182.
3.
Thomas M, Nesbitt C, Ghouri M, Hansrani M: Maintenance of hemodialysis vascular access and prevention of access dysfunction: a review. Ann Vasc Surg 2017; 43: 318–327.
4.
Schild AF: Maintaining vascular access: the management of hemodialysis arteriovenous grafts. J Vasc Access 2010; 11: 92–99.
5.
Gadallah MF, Paulson WD, Vickers B, Work J: Accuracy of Doppler ultrasound in diagnosing anatomic stenosis of hemodialysis arteriovenous access as compared with fistulography. Am J Kidney Dis 1998; 32: 273–277.
6.
Depairon M, Ferrier CP, Tutta P, Descombes E, van Melle G, Wauters JP: Is there a place for duplex screening of brachial artery in haemodialysis patients with vascular access? Vasa 2001; 30: 53–58.
7.
Visciano B, Riccio E, De Falco V, Musumeci A, Capuano I, Memoli A, Di Nuzzi A, Pisani A: Complications of native arteriovenous fistula: the role of color Doppler ultrasonography. Ther Apher Dial 2014; 18: 155–161.
8.
Zwiebel WJ: Duplex sonography of the cerebral arteries: efficacy, limitations, and indications. AJR Am J Roentgenol 1992; 158: 29–36.
9.
Napoli M, Tazza L, Postorino M, Bonucchi D, Lodi M, Granata A, Lomonte C, Meola M, Spina M: [The Italian registry of vascular access]. G Ital Nefrol 2013; 30:pii:gin/30.6.15.
10.
Lipari G, Tessitore N, Poli A, Bedogna V, Impedovo A, Lupo A, Baggio E: Outcomes of surgical revision of stenosed and thrombosed forearm arteriovenous fistulae for haemodialysis. Nephrol Dial Transplant 2007; 22: 2605–2612.
11.
Cho S: The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist. Kidney Res Clin Pract 2017; 36: 175–181.
12.
Jemcov TK: Morphologic and functional vessels characteristics assessed by ultrasonography for prediction of radiocephalic fistula maturation. J Vasc Access 2013; 14: 356–363.
13.
Finlay DE, Longley DG, Foshager MC, Letourneau JG: Duplex and color Doppler sonography of hemodialysis arteriovenous fistulas and grafts. Radiographics 1993; 13: 983–989.
14.
Grosser S, Kreymann G, Kuhns A, Greten H: [Color-coded duplex sonography in primary diagnosis, monitoring and prognostic evaluation of fibrinolytic and conservative therapy of thrombophlebitis]. Vasa Suppl 1991; 32: 187–190.
15.
Fumagalli G, De Pietro S, Migliori M, Ferrandello FP, Trovato F, Donadio C, Panichi V: Outcomes of vascular access care and surgery managed by interventional nephrologists: a twelve-year experience. Blood Purif 2016; 42: 111–120.
16.
Matsui S, Nakai K, Taniguchi T, Nagai T, Yokomatsu T, Kono Y, Mizoguchi T, Miki S, Yoshida A, Nagao K, Tsuji H, Ono S: Systematic evaluation of vascular access by color-Doppler ultrasound decreased the incidence of emergent vascular access intervention therapy and X-ray exposure time: a single-center observational study. Ther Apher Dial 2012; 16: 169–172.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.