Phlebography in the salage of dialysis fistulae

Provision of long-term satisfactory vascular access for haemodialysis is an increasing problem. The functional life of an arteriovenous fistula can be greatly extended by an active salvage policy to which radiology makes an invaluable contribution. Forty-seven consecutive patients with vascular access problems were studied, 11 undergoing forearm phlebography and 36 phlebography of a malfunctioning fistula. Of the 11 patients with forearm phlebograms, only one patient had a fistula constructed that was not used for dialysis, despite demonstration of a patent forearm venous system; and in three patients operation was avoided after demonstration of inadequate veins. Only three of the 36 fistulograms failed to give useful information, whereas in seven patients operation was avoided by demonstration of a normal fistulogram.