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Published online before print November 8, 2007, 10.1148/radiol.2463061942
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Clinically Immature Arteriovenous Hemodialysis Fistulas: Effect of US on Salvage1

Prabhleen Singh, MD, Michelle L. Robbin, MD, Mark E. Lockhart, MD, MPH, and Michael Allon, MD

1 From the Division of Nephrology and Hypertension, University of California San Diego, VA Health Care System, San Diego, Calif (P.S.); and Division of Nephrology (M.A.) and Department of Radiology (M.L.R., M.E.L.), University of Alabama at Birmingham, 619 19th St South, JTN350, Birmingham, AL 35249-6830. Received November 14, 2006; revision requested Januaury 17, 2007; revision received February 23; accepted March 21; final version accepted May 1. M.A. supported in part by grant 1 K24 DK59818-01 from the National Institute of Diabetes and Digestive and Kidney Diseases. Address correspondence to M.L.R. (e-mail: mrobbin{at}uabmc.edu).


Figure 1
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  		Figure 1: Normal diameter fistula. Transverse gray-scale image of draining vein shows adequate 6.6-mm diameter for hemodialysis (crosshairs). The depth (x) is 4.8 mm, which is less than the 5.0-mm threshold.

 

Figure 2
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  		Figure 2: Accessory vein. Transverse gray-scale image of draining vein shows a large accessory vein (crosshairs), which may limit maturation of the fistula for dialysis by sumping blood flow from the draining vein.

 

Figure 3A
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  		Figure 3a: Immature fistula. (a) Transverse gray-scale image of draining vein (crosshairs) shows the vein is too small and too deep for consistent cannulation at hemodialysis. (b) Longitudinal spectral Doppler US image with volume flow calculation demonstrates slow flow, consistent with fistula immaturity.

 

Figure 3B
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  		Figure 3b: Immature fistula. (a) Transverse gray-scale image of draining vein (crosshairs) shows the vein is too small and too deep for consistent cannulation at hemodialysis. (b) Longitudinal spectral Doppler US image with volume flow calculation demonstrates slow flow, consistent with fistula immaturity.

 




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