E2859. I Need a HeRO: Pre- and Post-Procedural Imaging Appearance of Hemodialysis Access
  1. Stephanie Jankovic; Oregon Health and Science University
  2. Marc Michael Lim; Oregon Health and Science University
Ultrasound is routinely used in initial evaluation of dysfunctional arteriovenous (AV) fistulas and grafts as it offers a convenient, noninvasive method of evaluation. Recognition of an abnormal finding on ultrasound can then allow for prompt and appropriate management including surgical, endovascular, and expectant. Correlation of ultrasound findings with angiographic findings will also aid the diagnostic radiologist in accurately describing abnormal imaging features.

Educational Goals / Teaching Points
Knowledge of surgical creation of hemodialysis access allows for accurate understanding of the imaging findings. Knowledge of normal appearance of the waveforms and velocities in fistulas or grafts allows detection of abnormal fistulas. Understanding of the angiographic imaging correlate aids in the understanding of sonographic findings. Understanding of the indications for, and techniques in, various interventions (surgical and endovascular) allows for prompt recommendation of management in dysfunctional access and accurate interpretation of the post-procedure findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomical and surgical review of types of AV fistulas and grafts. Clinical Indications for ultrasound evaluation of hemodialysis access including slow flow, prolonged bleeding, thrombosis and infected graft. Ultrasound findings and the underlying flow dynamics including physics of high and low resistance waveforms. Pathologies and treatment of arterial inflow and venous outflow with fistulas, grafts, and central lines including pathologies - stenoses, thrombus, aneurysm/pseudoaneurysm, steal syndrome and infection; and treatment - angio/venoplasty, stent placement, distal revascularization and interval ligation (DRIL), Hemodialysis Reliable Outflow (HeRO) grafts, and ligation of collateral vessels.

Knowledge of the expected pre- and postprocedural sonographic and angiographic findings of a hemodialysis fistula or graft allows for prompt recognition of abnormal findings, and thus appropriate recommendation for further management including surgical and endovascular. Various treatments for dysfunctional fistulas/grafts including plasty, stent, DRIL, and HeRO grafts will also have various imaging appearances.