Use of ultrasound to guide maturation and maintenance of surgical and percutaneous arteriovenous fistulas

<h2>Abstract</h2> The creation and maintenance of arteriovenous fistulas (AVFs) remain critical challenges in providing long-term vascular access for hemodialysis patients. Achieving timely maturation and addressing post-maturation complications require effective monitoring and intervention strategies. This technical note describes the use of ultrasound (US) as a primary tool for guiding maturation and maintaining both surgical and percutaneous AVFs. Unlike traditional angiographic imaging, US offers noninvasive, real-time, high-resolution visualization of treated pathology with simultaneous volume flow changes, tailoring the interventions according to access, patient, and dialysis needs. US-guided techniques not only facilitate early detection of complications, moreover, they allow precise assessment of stenoses and dynamic evaluation of interventions, reducing reliance on contrast agents and radiation exposure. Procedural benefits include improved treatment accuracy, reduced periprocedural vessel trauma, and tailored interventions based on individual vascular anatomy and dialysis needs. This approach enhances technical success and subsequently patency rates while minimizing risks and costs, making it a valuable addition to vascular access management. Widespread adoption of US-guided techniques has the potential to improve outcomes for hemodialysis patients by extending AVF longevity, reducing complications, and optimizing efficiency. The integration of US into routine vascular access care represents a significant advancement. Challenges, such as operator dependency and limitations in visualizing tortuous and central veins, underscore the need for specialized training.