NEPHRO-News
Introduction
Maintenance adaequate haemodialysis
therapy depends on a reliable access to circulation, preferably a
native arteriovenous fistula (AV fistula). As an AV fistula is a very
dynamic high flow construction and, in addition, cannulated repeatedly
it is prone to dysfunction and finally to failure, mostly thrombosis.
Aim of any type of management of fistula dysfunction is to restore an
intact and patent venous tube for long-term use. Recently, a tendency is
observed to treat the dysfunctional, failing fistula electively. Main
topics of this overwiew are stenosis, aneurysm, peripheral
ischaemia/steal syndrome and missing maturation. These remarks
concentrate on surgical aspects.
Diagnosis of the failing arteriovenous fistula
Early
diagnosis of the failing AV fistula is an essential goal for the
nephrologist and his staff. Bedside clinical examination - inspection,
palpation and auscultation - can reveal substantial findings, supported
by routinely obtained dialysis related parameters like arterial/venous
pressure and bleeding time after removal of cannulae. Case dependent,
ultrasound examination can support and confirm clinical findings. In our
institution, the synopsis of this simple procedure provides an exact
and reliable diagnosis in more than 80% of patients. Recirculation
studies are more predictive in AV grafts with outflow obstruction than
in AV fistulae. Repeated measurements of blood flow volume has proven a
valuable tool in various situations. In our experience, indications for
angiography have decreased during the past years except for diagnosis of
central vascular lesions.
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