Doppler ultrasound in the diagnosis of the complications of arteriovenous fistula

Arteriovenous fistulas (AVF) are surgical connections between an artery and a vein created to provide adequate vascular access for hemodialysis in patients with end-stage renal disease. Doppler ultrasound has become the choice method for the evaluation of AVF and their complications due to its wide availability, its low cost, and its ability to accurately evaluate the vascular system without the need for contrast or radiation. The objectives of this review are to review the most frequent complications of peripheral vascular access for hemodialysis, to describe the typical ultrasound findings to identify them, and to highlight the role of Doppler ultrasound in their early detection that allows actions to be taken in order to preserve this important vascular access. AVF failure usually occurs due to inflow or outflow stenosis that induces subsequent thrombosis. Less frequently, in mature AVF, complications derive from incorrect access management (hematoma, pseudoaneurysm, infection), from pathologies of the wall (aneurysm) or from changes in resistance that can decrease distal limb arterial perfusion (steal). In conclusion, Doppler ultrasound is a non-invasive and effective tool for the diagnosis of AVF for hemodialysis complications. Its systematic application in follow-up and in the presence of signs of failure can significantly improve clinical results and the quality of life of patients.