Hemodialysis access: Imaging diagnosis

A well functioning dialysis access is the lifeline for patients with end stage renal disease (ESRD) on hemodialysis. Dialysis access circuits include both arterio-venous fistulas (AVF) and arterio-venous grafts (AVG). An AV fistula is created by connecting a vein to an artery, resulting in one anastomosis. An AV graft is created when a biologically acceptable tube is connected to an artery at one end and to a vein at the other end, resulting in two anastomoses. The upper extremities are preferred over the lower extremities for dialysis access creation and fistulas have been shown to out-perform grafts in terms of durability and infection rates [1]. Maintaining a given dialysis access requires early detection of access dysfunction. The goal is to keep the dialysis access functioning such that adequate dialysis is achieved, as well as to prevent thrombosis of the access. Once dialysis access thromboses, its lifespan declines dramatically [1-3].