Algorithm of duplex ultrasound of permanent vascular access for hemodialysis

Algorithm of duplex ultrasound of permanent vascular  access for hemodialysis

Koen V.S., Zahmatova T.V., Sebelev K.I.

Purpose. To design the algorithm of vascular access for hemodialysis ultrasound examination.

Materials and methods. Duplex ultrasound was performed in 54 patients before vascular access creation and in 146 patients with functioning access. Inflow artery, anastomosis, outflow vein ware evaluated, vessels diameters, peak systolic velocity and access flow were measured.

Results. In 9.3% of patients forearm vessels of non-dominant arm were unsuitable for vascular access creation, that caused access formation on dominant arm, in 13.0% proximal fistula was created. Anastomosis diameter of failing to mature fistulas was 2.2±0.3 mm. Adequate access functioning was observed in fistulas with access flow of 600–1500 ml/min and 800–1700 ml/min in grafts.  Complications were detected in 43.8% of patients, stenosis in 19.9%, outflow vein thrombosis in 13.0%, aneurysmal dilation in 8.2%, hand ischemia in 2.7%.

Discussion. Artery with a diameter more than 2.0 mm and vein at least 2.5 mm with its depth of no more than 5-6 mm suit for creating vascular access. Minimal access flow that can provide effective hemodialysis is 350-400 ml/min, optimal – greater than 600 ml/min in fistula and 800 ml/min in graft. Criteria for stenosis are peak systolic velocity in the stenotic zone more than 400 cm/s, the ratio of peak systolic velocity in the pre-stenotic and post-stenotic zones more than 2.0 and the access flow decrease. Causes of steal syndrome are inflow artery stenosis, excessive access flow due to big anastomosis diameter and pathology of hand microcirculation.

Conclusion. As a result of the study the algorithm for duplex ultrasound of vascular access for hemodialysis was designed.

1 - North-West State Medical University named after I. I. Mechnikov Ministry of Healthcare Russia.

2 - National medical research center named after V. A. Almazov Ministry of Healthcare Russia.

Saint Petersburg, Russia.


Keywords: arteriovenous fistula, hemodialysis, duplex ultrasound, stenosis, thrombosis, hand ischemia.


Corresponding author:  Koen V. S., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript


For citation: Koen V.S., Zahmatova T.V., Sebelev K.I. Algorithm of duplex ultrasound of permanent vascular  access for hemodialysis. REJR 2020; 10(1):83-93. DOI:10.21569/2222-7415-2020-10-1-83-93.


Received:       15.02.20 Accepted:     01.03.20