Preprocedure Evaluation of a Dysfunctional Dialysis Access

Given the many different types of hemodialysis access and the various problems that can occur in each, a structured approach should be taken in the preprocedure evaluation of patients referred for hemodialysis access intervention. Abnormalities detected on surveillance or monitoring trigger referrals for evaluation and intervention in hopes of preventing thrombosis or underdialysis. Familiarity with surveillance and monitoring findings not only facilitates better communication with nephrologists but also helps the interventionalist surmise where the site of stenosis might be and which stenoses are clinically relevant. Additionally, knowing where stenoses are prone to occur (eg, the cephalic arch in brachiocephalic fistulas) and facility with performing and interpreting an on-table ultrasound are important in preprocedure planning.