Indications and Imaging Modalities in Dialysis Access

Abstract

Vascular access imaging is indicated in the presence of clinical abnormalities or for the prevention of acute thrombosis. Direct resort to fistulography often arises in the absence of easy access to Doppler ultrasonography because nephrologists and surgeons are convinced an underlining stenosis detected on clinical examination can be best be confirmed and dilated in the same sitting by the interventional radiologist. Computed tomography and magnetic resonance angiography have no place in the diagnosis of vascular access abnormalities as they do not provide to date a platform for concomitant therapeutic interventions. In addition, these two expensive modalities require venipuncture of the upper extremity veins for contrast injection unlike duplex ultrasonography, and there are definite hazards associated with iodinated and gadolinium-based contrast agents.