[Imaging of dialysis fistulae].

Vascular access malfunctions can be diagnosed by means of imaging and non-imaging methods. The former are: ultrasound (US), colour Doppler ultrasonography, arteriography and phlebography. Radiological imaging allows for direct assessment of the morphology and function of the hemodialysis fistula, and shows precisely the kind and location of lesions, that may lead to access failure. The aim of the study was to present the algorithm of methods employed in evaluation of hemodialysis fistulae, that had been developed by the authors. From March 1995 to July 2001, 1020 colour Doppler ultrasonography examinations were performed, followed by 250 angiographies of hemodialysis fistulae. In the studied group there were 170 well functioning hemo-dialysis fistulae. They were evaluated in order to establish normal blood flow parameters in the fistula. In 135 patients with symptoms of fistula failure US revealed the presence of pathological lesions, such as thrombosis or aneurysm of the venous branch. In 193 cases the presence of stenosis was stated. Three hundred eleven hemodialysis fistulae were sonographically evaluated before the patient was referred to surgical (81) or intravascular (230) treatment. Post-operative assessment was performed in 125 cases. In 231 cases, angiography confirmed the results of US. In 19 cases the degree of fistula stenosis was underestimated in colour Doppler sonography. Colour Doppler sonography is a method of choice in evaluation of arteriovenous hemodialysis fistulae. Abnormal results of physical examinations, dialysis parameters, as well as patients complaints associated with the fistula are indications to perform an ultrasound examination. Angiography is required in case of dubious US findings or as the first step in endovascular treatment.