Flow volume measured by duplex ultrasound in native arteriovenous fistula for hemodialysis: a case report

2021 ◽  
Vol 1 (2) ◽  
pp. 28-31
Author(s):  
Ronald Winardi Kartika
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Doppler Ultrasound ◽  
Vascular Access ◽  
Duplex Ultrasound ◽  
Sample Volume ◽  
Flow Volume ◽  
Pulsed Doppler ◽  
Av Fistula ◽  
Av Fistulas

Background : Native arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. AVF lasts longer than artificial grafts or central venous catheters. In addition, AVF has fewer complications than other vascular accesses. The use of Doppler ultrasound is used to facilitate fistula construction (vascular mapping) including AVF maturation to see if AVF can be used. Doppler ultrasound monitoring for maturation of AV fistulas should be monitored sonographically until the fistula is ready for use, especially when maturation is slow and in patients whose veins cannot easily be assessed by physical examination alone (eg because of obesity). The AVF DUS flow volume measurement may be the only imaging tool that can be used to monitor a fistula even during its maturation. Even so, DUS should always be done before AVF is used for the first time. This examination provides baseline data on vascular access, which can be useful in subsequent tests performed to evaluate functional problems. Case report : A man, 52 years old who has done AV Fitula two weeks ago. Currently patients are using a double lumen catheter (CDL) for routine hemodialysis. One day the patient had his CDL removed. Even though the patient feels thrill in the AV fistula, the nephrorologist still doubts whether the AV fistula is ripe and can be used. For this reason, a Duplex Ultrasound is performed to assess the diameter, velocity flow, PSV and TAMV  .By positioning the sample volume in the presumed stenosis site, the Doppler velocity test detects a systolic peak velocity. Conclusion:  Color flow Doppler imaging should be used as a tool to screen for areas of high velocity and to aid in the optimal placement of the pulsed Doppler sample volume. The pulsed Doppler sample volume should be set at the smallest size possible to detect discrete changes in blood flow meanwhile doppler ultrasound should be use in monitoring for maturation of AV fistulas

Atypical presentation of fistula dysfunction due to brachial arterial embolization mimicking stroke

2022 ◽  
pp. 112972982110676
Author(s):  
Rita Vicente ◽  
Laura Rodriguez ◽  
Joaquim Vallespín ◽  
Carolina Rubiella ◽  
Jose Ibeas
Keyword(s):  
Arteriovenous Fistula ◽  
Doppler Ultrasound ◽  
Vascular Access ◽  
Brachial Artery ◽  
Arterial Embolization ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Bedside Ultrasound ◽  
Computed Tomographic ◽  
Ultrasound Evaluation

Vascular access thrombosis is an important complication with great impact on access patency and, consequently, on a patient’s quality of life and survival. We report the case of a 73-year-old woman with chronic kidney disease on hemodialysis with a radiocephalic arteriovenous fistula on the right arm that was brought to the emergency department with decreased strength in her right arm, ipsilateral hypoesthesia and facial hemi-hypoesthesia. The patient was given a brain computed tomographic scan that did not confirm suspicion of stroke. On re-examination, the patient had new-onset pain at arteriovenous fistula level, and her right arm was cold and pale. The nephrology department was called for arteriovenous fistula evaluation. On physical examination, her forearm fistula had a decreased thrill and arm elevation exacerbated its paleness. A bedside ultrasound was performed for arteriovenous fistula assessment. Doppler ultrasound revealed: partial thrombosis at brachial bifurcation, a flow of 80–105 mL/min at brachial artery level and a radial artery with a damped waveform. Anastomosis and draining vein were permeable. In this case, the diagnosis of acute embolic brachial artery occlusion was made by a fast bedside ultrasound evaluation. The patient underwent thromboembolectomy with Fogarty technique, recovering fistula thrill, radial and cubital pulses. Thromboembolism of the fistula feeding artery is a rare cause of vascular access thrombosis and it is rarely mentioned in the literature. In this report, failure to recognize the upper limb ischemia would have led to delayed treatment, potentially resulting in the fistula’s complete thrombosis and further limb ischemia. We highlight the importance of a diagnosis method like Doppler ultrasound, which allows for rapid evaluation at the patient’s bedside.

Preoperative noninvasive artery flow volume and maturation of arteriovenous fistulae: A single surgeon’s experience from 403 cases

2019 ◽  
Vol 21 (4) ◽  
pp. 434-439
Author(s):  
George Blessios ◽  
Alexander Hlepas ◽  
Alonso Diaz
Keyword(s):  
Risk Factors ◽  
Arteriovenous Fistula ◽  
Doppler Ultrasound ◽  
Significant Risk ◽  
Flow Volume ◽  
Arterial Diameter ◽  
Ultrasound Evaluation ◽  
Maturation Rate ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Background: Preoperative Doppler ultrasound evaluation of arteriovenous fistula inflow artery includes measurements of arterial diameter and flow volume. The purpose of this study was to evaluate the significance of flow volume to arteriovenous fistula maturation rate. Study design: Review of consecutive patients who underwent arteriovenous fistula creation by a single surgeon. Cases with available preoperative arterial diameter and flow volume were analyzed. Primary end point was arteriovenous fistula failure to mature. Information collected included demographics, Doppler ultrasound reports, level of inflow artery, operative reports, and outcomes to the time of arteriovenous fistula maturation or failure. Risk factors were identified by logistic regression analysis. Outcomes were compared by odds ratio. Results: Four hundred and three cases were identified. Arterial diameter and flow volume were both independent significant risk factors affecting arteriovenous fistula maturation rate (p = 0.001). Arterial diameter of <2.5 mm and flow volume of <20 mL/min predicted failure to mature with 95% specificity. Further comparison of cases with optimal arterial diameter but flow volume of <20 mL/min showed increased failure to mature rate compared to the combination of optimal arterial diameter with optimal flow volume (p = 0.01) Conclusion: Preoperative arterial diameter and flow volume values were both significant independent variables affecting arteriovenous fistula maturation rate. However, flow volume of <20 mL/min remained a significant risk factor to failure-to-mature rate, despite optimal arterial diameter.

Contribution of inflow artery to observed flow in a vascular access: A computational fluid dynamic modeling study of an arteriovenous fistula circuit

2020 ◽  
pp. 112972982094406
Author(s):  
Jeffrey Krampf ◽  
Ramesh Agarwal ◽  
Surendra Shenoy
Keyword(s):  
Linear Relationship ◽  
Arteriovenous Fistula ◽  
Dynamic Modeling ◽  
Vascular Access ◽  
Computational Fluid Dynamic ◽  
Fluid Dynamic ◽  
Function Evaluation ◽  
Anastomotic Site ◽  
Flow Volume ◽  
Computational Fluid Dynamic Modeling

Introduction: The volume of blood flowing through the vascular access is an important parameter necessary to provide adequate dialysis for a functional arteriovenous fistula. Higher blood flows are seen in arteriovenous access that receive inflow from larger arteries such as brachial or axillary compared to those based on medium-caliber radial or ulnar arteries. We hypothesized that an anatomic difference in the length and the diameter of the artery is an important determinant of the flow volume in arteriovenous fistula created at different anatomic locations. Methods: Using computational fluid dynamics, we evaluated the contribution of the length and diameter of inflow artery on simulations performed with geometric models constructed to represent arteriovenous fistula circuits. Lengths and diameters of the inflow artery were altered to mimic arteriovenous fistula created at various locations of the upper extremity with standard and variant anatomy. Results: Models of arteriovenous fistula created with variable lengths and diameters of the inflow artery suggest that the length of the vessel has an inverse linear relationship and the diameter has a direct linear relationship to flow volume. Conclusion: Computational fluid dynamic modeling of arteriovenous fistula can be used to understand the physiologic basis of clinical observations of function. Evaluation of the effect of inflow artery length and diameter helps explain the higher flows seen in arteriovenous fistula created using large caliber arteries for inflow. Computational fluid dynamic modeling helps operators understand the contributions of inflow artery in access function and can guide anastomotic site selection.

scholarly journals Prevalence and Risk Factors of Arterio-Venous Fistula Obstruction on Patient with Chronic Kidney Disease

2021 ◽  
Vol 7 (2) ◽  
pp. 5
Author(s):  
Muhamad Taufik Ismail ◽  
Hariadi Hariawan ◽  
Yulia Wardhani ◽  
Metalia Puspitasari ◽  
I Putu Aditio Artayasa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Doppler Ultrasound ◽  
Duplex Ultrasound ◽  
Smoking Habits ◽  
Av Fistula ◽  
Venous Fistula

Prevalence and Risk Factors of Arterio-Venous Fistula Obstruction on Patient with Chronic Kidney Disease Ismail MT1, Hariawan H1, Wardhani Y2, Puspitasari M2, Artayasa IPA1, Ramadhan G1, Tarigan T1, Triatmaja R1   1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, 55284, Indonesia 2Department of Internal Medicine Faculty of Medicine Universitas Gadjah Mada-RSUP Dr. Sardjito Yogyakarta Indonesia   ABSTRACT Aim: AV fistula obstruction has become one of the main vascular access complications in patients undergoing haemodialysis. This complications have significant impacts on the morbidity and mortality of dialysis patients while also leading to higher medical costs. Clinical monitoring has been routinely used for early detection of AV fistula stenosis and obstruction, however screening with Doppler ultrasound is still not a routine recommendation. This study aims to know prevalence and risk factors of AV Fistula obstruction detected by Duplex ultrasound examination.   Methods: This study was a hospital-based descriptive analytic study with cross sectional design conducted at the haemodialysis center of National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. Patient demographic and clinical risk factor were recorded using direct interview. AV fistula obstruction were assessed using Duplex ultrasound by professional sonographer.   Results: Seventy four (74) patients are using AV fistula as entry access for hemodialysis in RSUP dr. Sardjito. It is consist of 39 male (53%) and 35 Female (47%). The mean age of patients is 50 years old. Surveillance using Doppler ultrasound found 20 patients (27%) have stenotic AV Fistula. Smoking habits (OR 5.37, 95% CI, 1.760 - 16.431, p=0.002) and diabetes mellitus (OR 5.00, 95% CI, 1.631 – 15.503, p=0.004) increase risk for having stenotic AV fistula. Only 4 patient (20 %) of all 20 patient with stenotic AV fistula were symptomatic, and needed for further vascular intervention   Conclusion: Prevalence of AV fistula obstruction detected by Doppler ultrasound was 27% of all AV fistula patient with only 5% had symptomatic AV fistula failure. Smoking habits and diabetes mellitus are important risk factor for AV fistula obstruction. Asymptomatic AV fistula obstruction often goes undetected by clinical monitoring that can increase of risk of symptomatic AV fistula obstruction in the future. The further study is needed to determine level recommendation of routine AV fistula surveillance with Doppler Ultrasound.   Key words: AV Fistula obstruction, CKD, Doppler ultrasound surveillance, Risk factors, Prevalence

scholarly journals Iatrogenic Radial Arteriovenous Fistula Secondary to Transradial Coronary Angiography: A Case Report

2020 ◽  
Vol 5 (01) ◽  
pp. 53-56
Author(s):  
Satish Kumar Rao V. ◽  
Srinivas Bhyravavajhala ◽  
Ramakrishna Narayanan ◽  
Sreekanth Yerram
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Coronary Angiography ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Rare Case ◽  
Access Site ◽  
Transradial Access ◽  
Percutaneous Coronary ◽  
Cardiovascular Interventions

AbstractTransradial access is the commonly followed route for performing percutaneous coronary diagnostic and angioplasty interventions. Transradial access has drastically decreased the vascular access site complications when compared with the transfemoral access. Arteriovenous fistula developing at the transradial access site is one of the rare complications. The risk factors and the mechanism of development are not entirely known. We present a rare case of a 63-year-old female developing radiocephalic fistula a few days after transradial coronary angiography and discuss management.The transradial route is preferred for cardiovascular interventions. Complications arising out of this are rare even though this route is widely used. Arteriovenous fistula is one of the rare complications, and the mechanisms causing it are not always clearly evident. This report will elaborate on the possible causes and steps to prevent this complication and help in managing once it occurs.

scholarly journals Blood Loss through AV Fistula: A Case Report and Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Fahad Saeed ◽  
Nadia Kousar ◽  
Ramapriya Sinnakirouchenan ◽  
Vijaya S. Ramalingam ◽  
Philip B. Johnson ◽  
...  
Keyword(s):  
Case Report ◽  
Blood Loss ◽  
Vascular Access ◽  
Blood Transfusions ◽  
Dialysis Access ◽  
Dialysis Catheter ◽  
Acute Blood Loss ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Hemodialysis Vascular Access

Little has been written about acute blood loss from hemodialysis vascular access. We describe a 57-year-old Caucasian male with an approximately 7 gm/dL drop in hemoglobin due to bleeding from a ruptured aneurysm in his right brachiocephalic arteriovenous fistula (AVF). There was no evidence of fistula infection. The patient was successfully managed by blood transfusions and insertion of a tunneled dialysis catheter for dialysis access. Later, the fistula was ligated and a new fistula was constructed in the opposite arm. Aneurysm should be considered in cases of acute vascular access bleeding in chronic dialysis patients.

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