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The role of Doppler ultrasonography in vascular access surveillance-controversies continue

Jan Malik1,2, Carlo Lomonte3, Mario Meola4

  • 1Center for Vascular Access, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.

The Journal of Vascular Access
|July 20, 2021
PubMed

Insights

Duplex Doppler ultrasound surveillance for arteriovenous access stenosis in hemodialysis patients shows conflicting results. Standardized criteria are needed to improve diagnosis and prolong access patency.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Radiology

Background:

  • Chronic hemodialysis necessitates reliable vascular access, with arteriovenous fistulas and grafts preferred over catheters due to lower morbidity and mortality.
  • Stenosis in these accesses reduces blood flow, leading to inadequate dialysis and potential thrombosis.
  • Current guidelines do not universally recommend ultrasound surveillance for asymptomatic stenosis.

Purpose of the Study:

  • To review existing trials on duplex Doppler ultrasound surveillance for arteriovenous access stenosis.
  • To analyze the reasons behind conflicting trial results and guideline recommendations.
  • To highlight the need for standardized criteria for diagnosing significant stenosis.

Main Methods:

  • Systematic review of published trials investigating duplex Doppler ultrasound for arteriovenous access stenosis.
  • Analysis of study methodologies, outcome measures, and reported results.
  • Evaluation of existing meta-analyses and their limitations.

Main Results:

  • Conflicting evidence exists regarding the efficacy of ultrasound surveillance in prolonging access patency.
  • Lack of standardized criteria for defining significant stenosis complicates interpretation of trial data.
  • Meta-analyses performed on existing studies are limited by methodological heterogeneity.

Conclusions:

  • Standardized, precise criteria for identifying significant arteriovenous access stenosis are crucial for accurate diagnosis.
  • Further research with standardized protocols is needed to clarify the role of ultrasound surveillance in hemodialysis access management.
  • Improved diagnostic criteria may lead to more effective interventions and better patient outcomes.

Keywords:
Hemodialysisarteriovenous fistulaarteriovenous grafthemodialysis vascular accessultrasonography

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