Vascular Laboratory Protocol and Ultrasound Mapping Techniques for Dialysis Access Planning

The successful placement of a dialysis access which is of utmost importance for patients with end-stage renal disease can be optimized by a pre-procedural evaluation that includes duplex ultrasound. Imaging of upper extremity superficial and deep veins for patency and caliber increases the frequency of autogenous dialysis access placement. Duplex arterial imaging and indirect physiologic testing should document normal arterial flow and provide information on the presence of radial artery wall calcification. The goal of duplex ultrasound testing is to provide the dialysis access surgeons with anatomic and physiologic information to construct a high-flow dialysis access and maximize the number of primary autogenous fistula performed. In this chapter, the preoperative work-up for dialysis access planning is detailed, including vein mapping of the superficial and deep veins and the arterial duplex imaging protocol.