Current techniques for assessment of upper extremity vasculature prior to hemodialysis vascular access creation

Vascular access problems lead to increased patient morbidity and mortality and place a large burden on care facilities, manpower and costs. Autogenous arteriovenous fistulas (AVF) are preferred over arteriovenous grafts (AVG) because of a lower incidence of vascular access related complications. An aggressive increase in the utilization of AVF, however, results in an increased incidence of AVF early failure and non-maturation. Increasing evidence suggests that routine preoperative assessment results in an increased utilization of functioning AVF by better selection of adequate vessels. To date, the reproducibility and standardization of assessment protocols are lacking and assessment of a single morphological parameter has not enabled adequate prediction of postoperative AVF function for individual patients. In this paper, we provide an overview of available diagnostic modalities and parameters that potentially enable better selection of adequate vessels for successful AVF creation.