The Role of Ultrasound Examination in the Assessment of Suitability of Calcified Arteries for Vascular Access Creation—Mini Review
Abstract
:1. Introduction
2. Prevalence of Calcifications in the Arteries of the Arm
3. Summary of Current Recommendations
4. How to Assess Calcified Arteries Prior to Vascular Access Creation
4.1. Methods for Detection and Quantification of Calcifications
4.1.1. Clinical Examination
4.1.2. Plain Radiograph
4.1.3. B-Mode Ultrasound
4.1.4. Compressibility of the Artery
4.1.5. Color Doppler Assessment
4.2. Functional Assessment of the Artery
4.2.1. Clinical Examination
4.2.2. Pulsed-Wave Doppler Assessment
Peak Systolic Velocity
Doppler Curve Assessment, Acceleration Parameters
Reactive Hyperemia Test
5. Outcomes of AVFs Placed on Calcified Arteries
6. Predicting Distal Ischemia in Patients with Calcified Arteries
6.1. Allen Test
6.2. Finger Pressure and Digital Brachial Index (DBI)
6.3. Ultrasound and Doppler Examination
7. Conclusions
7.1. Predicting the Difficulty of Clamping and Surgical Procedure
7.2. Predicting Successful Maturation
7.3. Predicting Distal Ischemia
Supplementary Materials
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Lanzer, P.; Boehm, M.; Sorribas, V.; Thiriet, M.; Janzen, J.; Zeller, T.; St Hilaire, C.; Shanahan, C. Medial vascular calcification revisited: Review and perspectives. Eur. Heart J. 2014, 35, 1515–1525. [Google Scholar] [CrossRef] [PubMed]
- Chen, Z.; Zhou, Y.; Yang, T. Histopathological assessment of radial artery calcification in patients with end-stage kidney disease. Ren. Fail. 2021, 43, 362–370. [Google Scholar] [CrossRef] [PubMed]
- Wang, N.; Yang, J.; Yu, X.; Hu, J.; Xing, C.; Ju, X.; Shen, X.; Qian, J.; Zhao, X.; Wang, X. Radial artery calcification in end-stage renal disease patients is associated with deposition of osteopontin and diminished expression of alpha-smooth muscle actin. Nephrology 2008, 13, 367–375. [Google Scholar] [CrossRef]
- Chen, J.; Budoff, M.J.; Reilly, M.P.; Yang, W.; Rosas, S.E.; Rahman, M.; Zhang, X.; Roy, J.A.; Lustigova, E.; Nessel, L.; et al. Coronary artery calcification and risk of cardiovascular disease and death among patients with chronic kidney disease. JAMA Cardiol. 2017, 2, 635–643. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Erlandsson, H.; Qureshi, A.R.; Ripsweden, J.; Löfman, I.H.; Söderberg, M.; Wennberg, L.; Lundgren, T.; Bruchfeld, A.; Brismar, T.B.; Stenvinkel, P. Scoring of medial arterial calcification predicts cardiovascular events and mortality after kidney transplantation. J. Intern. Med. 2022, 291, 813–823. [Google Scholar] [CrossRef] [PubMed]
- Schmidli, J.; Widmer, M.K.; Basile, C.; de Donato, G.; Gallieni, M.; Gibbons, C.P.; Haage, P.; Hamilton, G.; Hedin, U.; Kamper, L.; et al. Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur. J. Vasc. Endovasc. Surg. 2018, 55, 753–754. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Suresh Kumar, J.; Sajeev Kumar, K.S.; Arun Thomas, E.T.; Hareesh, K.G.; George, J. Prediction model for successful radiocephalic arteriovenous fistula creation in patients with diabetic nephropathy. Saudi J. Kidney Dis. Transpl. 2019, 30, 1058–1064. [Google Scholar] [CrossRef]
- Sadasivan, K.; Kunjuraman, U.; Murali, B.; Yadev, I.; Kochunarayanan, A. Factors Affecting the Patency of Radiocephalic Arteriovenous Fistulas Based on Clinico-Radiological Parameters. Cureus 2021, 13, e13678. [Google Scholar] [CrossRef]
- Georgiadis, G.S.; Georgakarakos, E.I.; Antoniou, G.A.; Panagoutsos, S.; Argyriou, C.; Mourvati, E.; Passadakis, P.; Lazarides, M.K. Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients. J. Vasc. Surg. 2014, 60, 462–470. [Google Scholar] [CrossRef] [Green Version]
- Allon, M.; Robbin, M.L.; Umphrey, H.R.; Young, C.J.; Deierhoi, M.H.; Goodman, J.; Hanaway, M.; Lockhart, M.E.; Barker-Finkel, J.; Litovsky, S. Preoperative arterial microcalcification and clinical outcomes of arteriovenous fistulas for hemodialysis. Am. J. Kidney Dis. 2015, 66, 84–90. [Google Scholar] [CrossRef] [Green Version]
- El Khoury, R.; Russeau, A.P.; Patel, N.; Dabbous, F.; Kechker, I.; Lipatov, S.; Ostrovski, T.; Jacobs, C.E.; White, J.V.; Schwartz, L.B. Reliability of preoperative venous mapping ultrasonography in predicting for autogenous arteriovenous fistula maturation. J. Vasc. Surg. 2021, 73, 1787–1793. [Google Scholar] [CrossRef] [PubMed]
- Li, H.L.; Chan, Y.C.; Cui, D.; Liu, J.; Wang, M.; Li, N.; Pai, P.; Cheng, S.W. Predictors of Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula in a Cohort of Asian Patients. Ann. Vasc. Surg. 2020, 66, 326–333. [Google Scholar] [CrossRef] [PubMed]
- Srivastava, A.; Sureka, S.K.; Prabhakaran, S.; Lal, H.; Ansari, M.S.; Kapoor, R. Role of Preoperative Duplex Ultrasonography to Predict Functional Maturation of Wrist Radiocephalic Arteriovenous Fistula: A Study on Indian Population. Indian J. Nephrol. 2018, 28, 10–14. [Google Scholar] [CrossRef]
- Persic, V.; Ponikvar, R.; Buturovic-Ponikvar, J. Preoperative ultrasonographic mapping of blood vessels before arteriovenous fistula construction in elderly patients with end-stage renal disease. Ther. Apher. Dial. 2009, 13, 334–339. [Google Scholar] [CrossRef]
- Cho, M.; Kim, J.S.; Cho, S.; Cho, W.P.; Choi, C.; Ahn, S.; Min, S.I.; Ha, J.; Min, S.K. Baseline characteristics of arm vessels by preoperative duplex ultrasonography in Korean patients for hemodialysis vascular access. J. Vasc. Access 2019, 20, 646–651. [Google Scholar] [CrossRef]
- Lok, C.E.; Huber, T.S.; Lee, T.; Shenoy, S.; Yevzlin, A.S.; Abreo, K.; Allon, M.; Asif, A.; Astor, B.C.; Glickman, M.H.; et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am. J. Kidney Dis. 2020, 75 (Suppl. S2), S1–S164. [Google Scholar] [CrossRef] [PubMed]
- Malovrh, M. Native arteriovenous fistula: Preoperative evaluation. Am. J. Kidney Dis. 2002, 39, 1218–1225. [Google Scholar] [CrossRef]
- Ferring, M.; Claridge, M.; Smith, S.A.; Wilmink, T. Routine preoperative vascular ultrasound improves patency and use of arteriovenous fistulas for hemodialysis: A randomized trial. Clin. J. Am. Soc. Nephrol. 2010, 5, 2236–2244. [Google Scholar] [CrossRef] [Green Version]
- Mihmanli, I.; Besirli, K.; Kurugoglu, S.; Haider, S.; Ogut, G.; Numan, F.; Canturk, E.; Sayin, A.G. Cephalic vein and hemodialysis fistula: Surgeon’s observation versus color Doppler ultrasonographic findings. J. Ultrasound Med. 2001, 20, 217–222. [Google Scholar] [CrossRef]
- Alves Lopes, J.R.; de Barros Marques, A.L.; Correa, J.A. Randomised clinical study of the impact of routine preoperative Doppler ultrasound for the outcome of autologous arteriovenous fistulas for haemodialysis. J. Vasc. Access 2021, 22, 107–114. [Google Scholar] [CrossRef]
- Gallieni, M.; Hollenbeck, M.; Inston, N.; Kumwenda, M.; Powell, S.; Tordoir, J.; Al Shakarchi, J.; Berger, P.; Bolignano, D.; Cassidy, D.; et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol. Dial. Transplant. 2019, 34, ii1–ii42. [Google Scholar] [CrossRef]
- Kim, J.J.; Koopmann, M.; Ihenachor, E.; Zeng, A.; Ryan, T.; deVirgilio, C. The addition of ultrasound arterial examination to upper extremity vein mapping before hemodialysis access. Ann. Vasc. Surg. 2016, 33, 109–115. [Google Scholar] [CrossRef]
- American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of ultrasound vascular mapping for preoperative planning of dialysis access. J. Ultrasound Med. 2012, 31, 173–181. [Google Scholar] [CrossRef] [Green Version]
- Liu, K.H.; Chu, W.C.W.; Kong, A.P.S.; Choi Ko, G.T.; Wan Ma, R.C.; Sang Chan, J.W.; Chow, L.T.C.; Rasalkar, D.D.; So, W.Y.; Tse, L.F.; et al. US assessment of medial arterial calcification: A sensitive marker of diabetes-related micro vascular and macrovascular complications. Radiology 2012, 265, 294–302. [Google Scholar] [CrossRef] [PubMed]
- Tian, J.; Tang, G.; Xu, X.; Yan, L.; Liang, M.; Zhang, W.; Liu, X.; Luo, B. Different Ultrasound Scoring Methods for Assessing Medial Arterial Calcification: Association with Diabetic Complications. Ultrasound Med. Biol. 2020, 46, 1365–1372. [Google Scholar] [CrossRef]
- Taylor, C.; Zielinski, L.P.; Chowdhury, M.M.; Coughlin, P.A. Defining the Role of Duplex Ultrasound Assessment to Determine Severity of Arterial Calcification: An Analysis of the Superficial Femoral Artery. J. Vasc. Ultrasound 2020, 44, 74–78. [Google Scholar] [CrossRef]
- Gubensek, J. Doppler ultrasound assessment of calcified radial arteries prior to radio-cephalic arterio-venous fistula placement—An observational study. J. Vasc. Access 2023, in press. [CrossRef]
- Georgakarakos, E.; Kostoglou, P. The “No Clamp” Technique for Anastomosis in Calcified Vessels. Eur. J. Vasc. Endovasc. Surg. 2020, 59, 483. [Google Scholar] [CrossRef] [PubMed]
- Napoli, M.; Barbarini, S.; Ria, P.; Zito, A.; Lefons, M.L.; De Pascalis, A. The intraoperative intravascular lithotripsy to recruit a calcified radial artery for creating a distal radio-cephalic fistula. J. Vasc. Access 2023, 24, 300–304. [Google Scholar] [CrossRef] [PubMed]
- Rocha-Singh, K.J.; Zeller, T.; Jaff, M.R. Peripheral arterial calcification: Prevalence, mechanism, detection, and clinical implications. Catheter. Cardiovasc. Interv. 2014, 83, E212–E220. [Google Scholar] [CrossRef] [Green Version]
- Pajek, J.; Malovrh, M. Preoperative ultrasound still valuable for radio-cephalic arteriovenous fistula creation? J. Vasc. Access 2017, 18 (Suppl. S1), 5–9. [Google Scholar] [CrossRef]
- Vallespin, J.; Meola, M.; Ibeas, J. Upper limb anatomy and preoperative mapping. J. Vasc. Access 2021, 22 (Suppl. S1), 9–17. [Google Scholar] [CrossRef] [PubMed]
- Horst, V.D.; Nelson, P.R.; Mallios, A.; Kempe, K.; Pandit, V.; Kim, H.; Jennings, W.C. Avoiding hemodialysis access-induced distal ischemia. J. Vasc. Access 2021, 22, 786–794. [Google Scholar] [CrossRef] [PubMed]
- Zachaus, M.; Herrmann, V.; Plehn, A.; Langer, T.; Podhaisky, H. Sonographic findings in the diagnostic course of vascular access for hemodialysis. Med. Klin. 2005, 100, 1–5. [Google Scholar] [CrossRef]
- Bardelli, M.; Veglio, F.; Arosio, E.; Cataliotti, A.; Valvo, E.; Morganti, A.; Italian Group for the Study of Renovascular Hypertension. New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis. Kidney Int. 2006, 69, 580–587. [Google Scholar] [CrossRef] [Green Version]
- Trihan, J.E.; Mahe, G.; Laroche, J.P.; Dauzat, M.; Perez-Martin, A.; Croquette, M.; Lanéelle, D. Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About? J. Clin. Med. 2023, 12, 1097. [Google Scholar] [CrossRef] [PubMed]
- Sedlacek, M.; Teodorescu, V.; Falk, A.; Vassalotti, J.A.; Uribarri, J. Hemodialysis access placement with preoperative noninvasive vascular mapping: Comparison between patients with and without diabetes. Am. J. Kidney Dis. 2001, 38, 560–564. [Google Scholar] [CrossRef]
- Lockhart, M.E.; Robbin, M.L.; Allon, M. Preoperative sonographic radial artery evaluation and correlation with subsequent radiocephalic fistula outcome. J. Ultrasound Med. 2004, 23, 161–168. [Google Scholar] [CrossRef]
- Smith, G.E.; Gohil, R.; Chetter, I.C. Factors affecting the patency of arteriovenous fistulas for dialysis access. J. Vasc. Surg. 2012, 55, 849–855. [Google Scholar] [CrossRef] [Green Version]
- Kim, E.S.; Sharma, A.M.; Scissons, R.; Dawson, D.; Eberhardt, R.T.; Gerhard-Herman, M.; Hughes, J.P.; Knight, S.; Kupinski, A.M.; Mahe, G.; et al. Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc. Med. 2020, 25, 484–506. [Google Scholar] [CrossRef]
- Spronk, S.; den Hoed, P.T.; de Jonge, L.C.W.; van Dijk, L.C.; Pattynama, P.M.T. Value of the duplex waveform at the common femoral artery for diagnosing obstructive aortoiliac disease. J. Vasc. Surg. 2005, 42, 236–242. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Brouwers, J.J.W.M.; Willems, S.A.; Goncalves, L.N.; Hamming, J.F.; Schepers, A. Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review. EClinicalMedicine 2022, 50, 101532. [Google Scholar] [CrossRef] [PubMed]
- Trihan, J.E.; Mahe, G.; Croquette, M.; Coutant, V.; Thollot, C.; Guillaumat, J.; Lanéelle, D. Acceleration Time of Distal Arteries to Diagnose Severe Peripheral Arterial Disease. Front. Cardiovasc. Med. 2022, 8, 744354. [Google Scholar] [CrossRef] [PubMed]
- Yagyu, T.; Funabashi, S.; Yoneda, S.; Noguchi, T.; Yasuda, S. Novel Evaluation Method for Lower Extremity Peripheral Artery Disease With Duplex Ultrasound—Usefulness of Acceleration Time. Circ. J. 2020, 84, 1990–1998. [Google Scholar] [CrossRef] [PubMed]
- Rosenberry, R.; Nelson, X.M.D. Reactive hyperemia: A review of methods, mechanisms, and considerations. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2020, 318, R605–R618. [Google Scholar] [CrossRef] [PubMed]
- Wall, L.P.; Gasparis, A.; Callahan, S.; van Bemmelen, P.; Criado, E.; Ricotta, J. Impaired hyperemic response is predictive of early access failure. Ann. Vasc. Surg. 2004, 18, 167–171. [Google Scholar] [CrossRef]
- Kanta Ghosh, N.; Kumar Bhattacharjee, H.; Prajapati, O.; Krishna, A.; Kumar, A.; Mahajan, S.; Kumar Bansal, V. Impact of clinical parameters and vascular haemodynamics on arterio-venous fistula maturation in patients with end stage renal disease: A prospective study on Indian patients. J. Vasc. Access 2022, 23, 508–514. [Google Scholar] [CrossRef] [PubMed]
- Meena, P.; Bhargava, V.; Sehrawat, S.; Singh Rana, D.; Kumar Bhalla, A.; Gupta, A.; Malik, M.; Gupta, A.; Tiwari, V. Stretching the boundaries: Suitability of an arteriovenous fistula in elderly patients on hemodialysis-a northern India experience. Int. Urol. Nephrol. 2022, 54, 671–678. [Google Scholar] [CrossRef]
- Masengu, A.; McDaid, J.; Maxwell, A.P.; Hanko, J.B. Preoperative radial artery volume flow is predictive of arteriovenous fistula outcomes. J. Vasc. Surg. 2016, 63, 429–435. [Google Scholar] [CrossRef] [Green Version]
- Bonucchi, D.; Cappelli, G.; Albertazzi, A. Which is the preferred vascular access in diabetic patients? A view from Europe. Nephrol. Dial. Transplant. 2002, 17, 20–22. [Google Scholar] [CrossRef] [Green Version]
- Kim, S.M.; Jung, I.M.; Kim, D.; So, Y.H. Effect of Inflow Arterial Calcification on Arteriovenous Fistula Maturation. Ann. Vasc. Surg. 2019, 58, 331–337. [Google Scholar] [CrossRef]
- Huber, T.S.; Larive, B.; Imrey, P.B.; Radeva, M.K.; Kaufman, J.M.; Kraiss, L.W.; Farber, A.M.; Berceli, S.A.; HFM Study Group. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J. Vasc. Surg. 2016, 64, 1050–1058.e1. [Google Scholar] [CrossRef] [Green Version]
- Kudlaty, E.A.; Kendrick, D.E.; Allemang, M.T.; Kashyap, V.S.; Wong, V.L. Upper Extremity Steal Syndrome Is Associated with Atherosclerotic Burden and Access Configuration. Ann. Vasc. Surg. 2016, 35, 82–87. [Google Scholar] [CrossRef]
- Morsy, A.H.; Kulbaski, M.; Chen, C.; Isiklar, H.; Lumsden, A.B. Incidence and characteristics of patients with hand ischemia after a hemodialysis access procedure. J. Surg. Res. 1998, 74, 8–10. [Google Scholar] [CrossRef]
- Vajdic Trampuz, B.; Arnol, M.; Gubensek, J.; Ponikvar, R.; Buturović Ponikvar, J. A national cohort study on hemodialysis arteriovenous fistulas after kidney transplantation—Long-term patency, use and complications. BMC Nephrol. 2021, 22, 344. [Google Scholar] [CrossRef] [PubMed]
- Beathard, G.A.; Spergel, L.M. Hand ischemia associated with dialysis vascular access: An individualized access flow-based approach to therapy. Semin. Dial. 2013, 26, 287–314. [Google Scholar] [CrossRef]
- Jennings, W.C.; Mallios, A.; Mushtaq, N. Proximal radial artery arteriovenous fistula for hemodialysis vascular access. J. Vasc. Surg. 2018, 67, 244–253. [Google Scholar] [CrossRef] [Green Version]
- van Hoek, F.; Scheltinga, M.R.; Kouwenberg, I.; Moret, K.E.M.; Beerenhout, C.H.; Tordoir, J.H.M. Steal in hemodialysis patients depends on type of vascular access. Eur. J. Vasc. Endovasc. Surg. 2006, 32, 710–717. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tordoir, J.H.M.; Bode, A.S.; van Loon, M.M. Preferred strategy for hemodialysis access creation in elderly patients. Eur. J. Vasc. Endovasc. Surg. 2015, 49, 738–743. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lazarides, M.K.; Staramos, D.N.; Kopadis, G.; Maltezos, C.; Tzilalis, V.D.; Georgiadis, G.S. Onset of arterial ‘steal’ following proximal angioaccess: Immediate and delayed types. Nephrol. Dial. Transplant. 2003, 18, 2387–2390. [Google Scholar] [CrossRef] [Green Version]
- Keuter, X.H.A.; Kessels, A.G.H.; de Haan, M.H.; van der Sande, F.M.; Tordoir, J.H.M. Prospective evaluation of ischemia in brachial-basilic and forearm prosthetic arteriovenous fistulas for hemodialysis. Eur. J. Vasc. Endovasc. Surg. 2008, 35, 619–624. [Google Scholar] [CrossRef] [Green Version]
- Ferraresi, R.; Acuna-Valerio, J.; Ferraris, M.; Fresa, M.; Hamade, M.; Danzi, G.B.; Gandini, R.; Mauri, G. Angiographic study of upper limb vascularization in a large cohort of hemodialysis patients with critical hand ischemia. Minerva Cardioangiol. 2016, 64, 642–647. [Google Scholar]
- Tatoulis, J.; Royse, A.G.; Buxton, B.F.; Fuller, J.A.; Skillington, P.D.; Goldblatt, J.C.; Brown, R.P.; Rowland, M.A. The radial artery in coronary surgery: 5-year experience-clinical and angiographic results. Ann. Thorac. Surg. 2002, 73, 143–148. [Google Scholar] [CrossRef] [PubMed]
- Manabe, S.; Tabuchi, N.; Tanaka, H.; Arai, H.; Sunamori, M. Hand circulation after radial artery harvest for coronary artery bypass grafting. J. Med. Dent. Sci. 2005, 52, 101–137. [Google Scholar] [PubMed]
- Abu-Omar, Y.; Mussa, S.; Anastasiadis, K.; Steel, S.; Hands, L.; Taggart, D.P. Duplex Ultrasonography Predicts Safety of Radial Artery Harvest in the Presence of an Abnormal Allen Test. Ann. Thorac. Surg. 2004, 77, 116–119. [Google Scholar] [CrossRef] [PubMed]
- van der Heijden, D.J.; van Leeuwen, M.A.H.; Ritt, M.J.P.F.; van de Ven, P.M.; van Royen, N. Chronic radial artery occlusion does not cause exercise induced hand ischemia. J. Interv. Cardiol. 2018, 31, 949–956. [Google Scholar] [CrossRef]
- Khalil, I.M.; Livingston, D.H. The management of steal syndrome occurring after access for dialysis. J. Vasc. Surg. 1988, 7, 572–573. [Google Scholar] [CrossRef] [Green Version]
- Valentine, R.J.; Bouch, C.W.; Scott, D.J.; Li, S.; Jackson, M.R.; Modrall, J.G.; Clagett, G.P. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J. Vasc. Surg. 2002, 36, 351–356. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Beathard, G.A.; Jennings, W.C.; Wasse, H.; Shenoy, S.; Hentschel, D.M.; Abreo, K.; Urbanes, A.; Nassar, G.; Dolmatch, B.; Davidson, I.; et al. ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists. J. Vasc. Access 2020, 21, 543–553. [Google Scholar] [CrossRef] [Green Version]
- Yadav, R.; Gerrickens, M.W.M.; Teijink, J.A.W.; Scheltinga, M.R.M. Systolic finger pressures during an Allen test before hemodialysis access construction predict severe postoperative hand ischemia. J. Vasc. Surg. 2021, 74, 2040–2046. [Google Scholar] [CrossRef]
Calcification Grade | B-Mode Image | Color Doppler Image | Appropriateness for Fistula Creation |
---|---|---|---|
none | smooth vessel wall, clear separation of intima and media | homogenous signal | yes |
mild | minor wall structure irregularities, increased echogenicity with spotty calcifications but without distal shadowing | homogenous signal | yes |
moderate | irregular wall structure, intermittent calcifications with distal shadowing or linear calcifications with incomplete distal shadowing | partly homogenous signal (drop outs <50% of visible artery length) | likely |
severe | irregular wall structure with diminished separation from surrounding tissue, continuous calcification of the wall with distal shadowing | very patchy (drop outs >50% of visible artery length) or almost absent signal | Not likely/careful consideration |
Reference | N in the Calcified Group | Degree of Calcifications | Clinical Maturation Rate | 1-Year Secondary Patency Rate |
---|---|---|---|---|
Sedlacek, 2001 [37] | 25 | not graded | 80% | / |
Georgiadis, 2014 [9] | 47 | moderate? | 89% * | 52% |
Srivastava, 2018 [13] | 17 | not graded | 48% | / |
Kim, 2019 [51] | 18 | mild (spoty) | 93% | / |
Suresh Kumar, 2019 [7] | 9 | moderate/severe? | 22% | / |
Sadasivan, 2021 [8] | 11 3 | mild/moderate severe | 73% 33% | / / |
Gubensek, 2022 [27] | 18 | moderate/severe | 67% | 66% |
Method | Advantages | Disadvantages |
---|---|---|
clinical examination (palpation of the arterial wall, presence of the pulse) | simple, no equipment needed, predictive of primary AVF failure [7] | subjective, no grading of severity of calcifications, no assessment of the site of anastomosis |
plain radiograph | simple, predictive of primary AVF failure [7,9] | patient irradiation, no grading of severity of calcifications at the site of anastomosis |
B-mode and color Doppler ultrasounds (presence and grading of calcifications, compressibility of the artery) | calcifications severity grading possible, assessment of the site of anastomosis, predictive of functional maturation [13] | partially subjective, depends on operator and experience |
Method | Advantages | Disadvantages |
---|---|---|
clinical examination (presence of the pulse, difference in blood pressure on both arms) | simple | moderate sensitivity for detection of proximal stenosis |
Doppler ultrasound (PSV, assessment of the shape of doppler curve, AT, Accmax) | objective, successfully used in other vascular beds to exclude significant proximal stenosis | moderately time consuming, no cut-off values validated in the field of vascular access |
Doppler ultrasound (RI during reactive hyperemia) | functional test, mimics the conditions after AVF creation | time consuming, no clear cut-off value, effect on AVF outcome unclear [17,27,38] |
Method | Advantages | Disadvantages |
---|---|---|
clinical examination (Allen test, presence of the pulse) | simple | likely not predictive of distal ischemia [67] |
plethysmography (finger pressure, DBI, delta finger pressure) | objective, used in other vascular beds | time consuming, no clear cut-off value, predictive value uncertain [61,68,70] |
Doppler ultrasound | objective, likely an alternative to plethysmography | no parameters established yet |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Gubensek, J. The Role of Ultrasound Examination in the Assessment of Suitability of Calcified Arteries for Vascular Access Creation—Mini Review. Diagnostics 2023, 13, 2660. https://doi.org/10.3390/diagnostics13162660
Gubensek J. The Role of Ultrasound Examination in the Assessment of Suitability of Calcified Arteries for Vascular Access Creation—Mini Review. Diagnostics. 2023; 13(16):2660. https://doi.org/10.3390/diagnostics13162660
Chicago/Turabian StyleGubensek, Jakob. 2023. "The Role of Ultrasound Examination in the Assessment of Suitability of Calcified Arteries for Vascular Access Creation—Mini Review" Diagnostics 13, no. 16: 2660. https://doi.org/10.3390/diagnostics13162660