Non-invasive imaging of dialysis access circuit

Duplex ultrasound is the mainstay for noninvasive evaluation of dialysis access circuits. It is used preoperatively for vein mapping and to detect peripheral arterial disease. Routine surveillance imaging of dialysis circuits is controversial, but duplex ultrasound is typically used when access circuit dysfunction (such as lack of thrill or pulse, poor clearance, aneurysm formation, lack of maturation, and hand ischemia) is suspected clinically. Duplex is useful to detect access circuit thrombosis, inflow and outflow stenosis, hematoma or collection adjacent to the circuit, collateral veins and distal arterial disease. CT and MR are used for evaluation of central venous and arterial structures in the chest and abdomen.