Interrupting Rivaling Access-flow with Nonsurgical Image-guided ligation: the "IRANI" Procedure

Clinical Aspects of Dialysis Interventions: Physical and Sonographic Findings

Physical examination (PE) of arteriovenous access remains of high clinical value and continues to be recommended by leading societies and guidelines. PE is easy to learn and perform. Once learned, examiners can provide a comprehensive arteriovenous (AV) access examination in 20 to 30 seconds. Therefore, we continue to advocate that AV access PE should be part of the training for all dialysis care providers. Similarly, ultrasound can provide important AV access evaluation and provide key information. It is relatively cheap and can be readily available at the bed side. Additionally, it is well accepted by patients, as it is not expected to be associated with pain or discomfort during the examination. We present in this review the key components of PE, signs and symptoms of AV access dysfunction, and the role of ultrasound in AV access evaluation as a complementary tool to PE.

Ultrasound in dialysis access: Opportunities and challenges

Sonography is increasingly being used by nephrologists and the field of dialysis access is no exception. Advances in technology have allowed the addition of this universally available, portable, non-invasive tool to the nephrologist's armamentarium, which provides information on both morphology and physiology without the need for contrast or radiation. Ultrasound may be used across the spectrum of dialysis access, including central venous catheter placements, vascular mapping, regional anesthesia, creation, maintenance and assessment of hemodialysis access as well as assessment of the abdominal wall and peritoneal dialysis catheter placements. However, the lack of exposure in most training programs limits incorporation of routine use of ultrasounds in nephrology practice. As our specialty embarks on the ultrasound revolution, a two-pronged approach is essential to provide ample training opportunities while ensuring establishment of basic standards for training and competency.