Challenge for the interventional nephrologist: monitoring the arteriovenous fistula

Arteriovenous fistula (AVF) has been recommended as the first choice for hemodialysis vascular access. This is supported by its superior patency and lower complication rates over grafts and catheters. The increasing incidence of end-stage renal disease patients and consequently higher prevalence of AVF in hemodialysis units have augmented the necessity for a better understanding of AVF peculiarities. As for grafts, the K/DOQI Work Group recommends the routine use of techniques for monitoring AVF to detect dysfunctional access with stenosis and its consequent correction in an attempt to reduce thrombotic episodes, cost and improving quality of life of these patients. All members of a vascular access team should be able to recognize a dysfunctional vascular access and determine the exact moment to intervene. Particularly for the interventionist, these techniques may be used to assist percutaneous transluminal angioplasty, providing information about the success of the procedure and access patency. The present article discusses the methods of AVF surveillance that are routinely performed for hemodialysis patients with the purpose to detect stenosis, reduce thrombosis and assist procedures.