Stenosis in hemodialysis arteriovenous fistula: evaluation and treatment

Area of Science:

• Nephrology
• Vascular Surgery
• Radiology

Background:

• Vascular access complications significantly increase morbidity and mortality in stage 5 chronic kidney disease patients.
• Arteriovenous fistula is the preferred vascular access for hemodialysis due to its high patency and low complication rates.
• Stenosis is the primary cause of arteriovenous fistula dysfunction, necessitating vigilant surveillance.

Purpose of the Study:

• To highlight the importance of arteriovenous fistula surveillance for detecting stenosis.
• To discuss various surveillance methods, including physical examination, intra-access pressure, recirculation, and blood flow measurements.
• To emphasize the significance of timely correction procedures for arteriovenous fistula stenosis.

Main Methods:

• Case report of a hemodialysis patient with inadequate Kt/V.
• Investigation involving physical examination and intra-access pressure monitoring.
• Diagnosis of venous stenosis via Doppler ultrasound.

Main Results:

• Abnormal physical examination findings and altered intra-access pressure measurements indicated fistula dysfunction.
• Doppler ultrasound confirmed venous stenosis as the cause.
• Percutaneous transluminal angioplasty was successfully performed to treat the stenosis.

Conclusions:

• Early detection of arteriovenous fistula stenosis through comprehensive surveillance is vital for maintaining hemodialysis adequacy.
• Intra-access pressure monitoring and Doppler ultrasound are effective diagnostic tools.
• Prompt angioplasty can correct stenosis and improve patient outcomes.