Ultrasound in Vascular Access

Jason Wellen and Surendra Shenoy

Hemodialysis is the most prevalent renal replacement therapy for patients developing end-stage renal disease (ESRD). Survival on dialysis is directly related to the adequacy of dialysis, which, in turn, substantially relies on the nature of dialysis access. Arteriovenous fistula (AVF), with superior long-term outcomes, is considered the preferred access for long-term hemodialysis (HD).1 Compared with other industrialized countries, the prevalence rate of AVF is lowest amongst ESRD patients who are dialysis dependent in the United States.2,3 In an attempt to increase AVF prevalence, Centers for Medicare and Medicaid Services (CMS) launched the Fistula First initiative in 2004. As a result, the incidence of AVF in the United States has risen from 27% in 2003 to over 50% and continues to increase.4 Preoperative vessel mapping ranks high among the “change concepts” advocated by Fistula First that have contributed to this increase in AVF constructions.5 Currently the use of ultrasound has evolved as a preferred technique for vascular mapping in planning for AVF. Besides vessel mapping, realtime ultrasound also can play an important role in other aspects of vascular access management. This chapter will discuss the use of ultrasound in planning and management of vascular access in ESRD patients.

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