The role of color flow Doppler ultrasound in dialysis access

Color flow Doppler provides accurate imaging and access flow volume measurement of the hemodialysis vascular access. It can readily identify subsets of patients at high risk for future thrombosis. It is noninvasive, mobile, and allows convenient clinical evaluation at the dialysis facility. In Europe, Doppler ultrasound has become the standard of care for evaluation of arteriovenous (AV) fistula dysfunction and is essential in the preoperative evaluation for access placement. It also can diagnose the arterial inflow disease that has become more prevalent in our aging, diabetic, end-stage renal disease (ESRD) population. Access management programs based on Doppler ultrasound have been highly successful and have produced outcome data as good or better than provided with other techniques. In light of its proven clinical efficacy, reimbursement and regulatory agencies should allow its appropriate inclusion into integrated access management programs. In conclusion, Doppler ultrasound should be included as a part of an integrated vascular access management program. This is supported by clinical outcome data and direct comparisons with other modalities.