With over 100,000 patients on chronic hemodialysis, duplex ultrasonography is often called upon to evaluate patients with dialysis access sites for potential defects and complications prior to graft failure from thrombosis.
Clinical indications include:
- Change in the bruit or palpable thrill of the graft
- Prolonged dialysis times
- Elevated venous pressure found during dialysis
- Difficult needle placement for dialysis
- Underdeveloped fistula
- Abnormal lab values
- Perigraft mass
- Arm swelling, and digital pain, numbness or tingling
The dialysis “system” is evaluated in its entirety with Color duplex ultrasound. This includes the inflow through the subclavian, axillary, and brachial arteries and the outflow of the access site, throughout the venous system and back up to the neck.
Graft failure from thrombosis is often secondary to fibrointimal hyperplasia at the distal anastomosis between the graft and the vein. Other complications may include perigraft fluid collections, hematoma, pseudoaneurysm, and aneurysm.