This document discusses clinical and radiological evaluation of arteriovenous (AV) fistulas for hemodialysis access. It notes the requirements for a suitable AV fistula including a good caliber artery and vein. Assessment involves both clinical examination and ultrasound or color Doppler imaging to evaluate anatomy and complications. Doppler evaluation is important for diagnosing issues like thrombus, stenosis, occlusion, steal syndrome, pseudoaneurysm, and evaluating solutions like access salvage, revision, new sites, angioplasty, or ligation. Complications to watch for include reduced dialysis flow rates, increased venous pressures, prolonged bleeding, difficulty cannulating, swelling, enlarged veins, pain/discoloration of fingers, aneurysmal de

1. DR. PRAVEEN SINGHAL
INTERVENTIONAL RADIOLOGIST

2. THANKS TEAM APEX
WELCOME ALL PARTICIPANTS

3. CLINICAL AND SONOLOGICAL
EVALUATION OF AV FISTULA –
DR. PRAVEEN SINGHAL
AV FISTULA CARE –
MR. RAJENDRA KUMAR

4. WHAT IS AV FISTULA

5. REQUIREMENTS
• Good caliber artery – radial or brachial
• Good returning vein – caliber, appearance and
course
• Suitable superficial site

6. ASSESSMENT
• CLINICAL
• RADIOLOGICAL – USG OR COLOR DOPPLER
EXAMINATION

7. WHY IMPORTANT
• Borderline cases – more cases
• Anatomy and course
• Arm veins
• Neck veins
• Medico-legal aspect
• Difficult cases – more cases - examples

8. DOPPLER - AN ART !!

9. COMPLICATIONS IN FISTULA PATIENTS
DO
NOT
IGNORE

10. Reduction in flow rates during dialysis
i.e less than 250 ml/min

11. If there is increase in venous pressure
in the machine during dialysis

12. If there is prolonged bleeding after
removal of dialysis needle

13. Cant feel the good thrill

14. If there is persistent difficulty in
cannulation of fistula

15. If there is swelling in your fingers,
hand, forarm,arm, face or neck
region

16. If u seen enlarged prominent veins on
your arm, neck or chest region

17. • Patient complains of excessive pain bluish
discoloration, weakness and numbness of
fingers during dialysis and some relaxation
after dialysis
• Some time gangrene and ulceration at finger
tips

18. • Excessive swelling or ballooning at the site of
needling or along the course of the vein
• Acute – pseudoaneurysm
• Chronic – aneurysmal degeneration

19. CHANGE IN SKIN COLOR
OR
ULCERATIONS

20. DOPPLER EVALUATION IN CASE OF
COMPLICATION DUE TO AV FISTULA
• Diagnosis
• Solution

21. DIAGNOSIS
• THROMBUS
• STENOSIS IN CEPHALIC VEIN
• CENTRAL VEIN OCCLUSION
• STEAL SYNDROME
• RETROGRADE FLOW IN VENOUS TRIBUTARY
• COLLATERAL FLOW
• POOR ARTERIAL INFLOW
• PSEUDOANEURYSM
• HEMATOMA

23. SOLUTION
• ACCESS SALVAGE
• REVISION OF AVF
• NEW SITE AVF
• PSA MANAGEMENT
• RADIAL ARTERY ANGIOPLASTY
• MANAGEMENT OF STEAL SYNDROME
• LIGATION / COIL

24. SOME EXAMPLES