Application Of Ultrasound In Autogenous Arteriovenous Fistula

Background: Chronic kidney disease(CKD)is a common clinical disease,with about 120 million patients in China.End-stage renal disease(ESRD)is the ultimate outcome of CKD.In patients with ESRD,the renal function is completely lost and effective treatment is required to replace renal excretory function.Renal transplantation,peritoneal dialysis,and maintenance hemodialysis can replace renal excretory function.Kidney transplantation is difficult for most patients due to the shortage of kidney resources,high cost and rejection after kidney transplantation.Peritoneal dialysis is rarely used clinically due to its complications.Currently,maintenance hemodialysis is the most effective treatment for patients with ESRD.At present,the main access of maintenance hemodialysis includes autologous arteriovenous fistula,graft arteriovenous fistula and central venous catheterization.Autologous arteriovenous fistula is the most effective vascular access for hemodialysis because of its low incidence of complications,good patency and long service life.Functional vascular access is necessary for normal hemodialysis.In recent years,with the rapid development of ultrasound technology,ultrasound plays an important rolein autologous arteriovenous fistula.Preoperative ultrasound assessment of vessels,screening of fistula vessels can improve the success rate of surgery,while improving the rate of internal fistula maturation,the values of ultrasound in postoperative assessment of fistula maturation,long-term monitoring of fistula and timely discover the complications and ultrasound guided interventional treatment have also been recognized clinically.Objective: To review the related literatures and summarize the applications of ultrasound in autologous arteriovenous fistula.Methods: A total of 72 literatures were reviewed and analyzed,including 50 literatures from 2010 to 2019,14 literatures from 2000 to2009,7 literatures from 1990 to 1999,and 1 literature from 1982,we reviewed 46 literatures in English and 26 literatures in Chinese.Conclusion: The values of ultrasound in autogenous arteriovenous fistula lie in:(1)the preoperative assessment,screening vessels.Ultrasound mainly assesses arterial diameter,blood flow and venous diameter,distance from skin to the vein,if the artery has calcification and branches or not,after that,we can mark the most suitable vessels for access and improve the success rate of surgery and internal fistula maturity.(2)evaluating the maturation of internal fistula before hemodialysis with the fistula.It can decrease complications caused by using immature internal fistula,increase the service life of access,as for immature internal fistula discovered by ultrasound,positive steps shall be taken to promote maturity.(3)long-termmonitoring conditions of internal fistula during dialysis.Ultrasound is helpful in timely discover dialysis-related complications and guiding interventional treatment to save the internal fistula.