Ultrasonography Mapping of Blood Vessels Before Arteriovenous Fistula Construction

End-stage renal disease (ESRD) leads to severe illness and death if left untreated. The number of patients requiring renal replacement therapy by haemodialysis is rising rapidly [12]. A well functioning vascular access is a prerequisite for successful haemodialysis treatment. Achieving long-term haemodialysis vascular access is becoming a challenge because of an increase in elderly haemodialysis patients with various comorbidities that are associated with poor and diseased vessels. This makes successful vascular access creation cumbersome [3]. To reduce vascular access related complications, autogenous arteriovenous fistulas (AVF) are preferred over arteriovenous grafts (AVG) [3,4]. The clinical success of AVF is jeopardized by high early failure and non-maturation rates. Early failure and no-maturation necessitate salvage procedures and the use of indwelling central venous catheters. Guidelines recommend the use of diagnostic modalities, duplex ultrasound (DUS) in particular, to enable tailored vascular access creation for individual patients to avoid vascular access early failure and non-maturation [3,4]. In order to increase the number of mature and functional AVFs, adequate history taking, physical examination and preoperative assessment of upper extremity vessels are important to potentially prevent early AVF thrombosis. Increasingly, arterial and venous diameters as well as the presence and location of pre-existing atherosclerotic occlusive disease and venous stenosis, occlusions and side-branches are used to guide the choice of fistula type and location. Consequently, interest has risen in preoperative imaging of upper extremity vessels. The goal of preoperative imaging is assessment of vessel calibre and identification of sites where arteries and veins are of suboptimal quality of access purposes [5-8]. The current review will provide the radiologist and nephrologists with an overview of the clinical role and relative merits and shortcomings of physical examination and DUS in the preoperative work-up of patients awaiting surgical creation of vascular access for haemodialysis.