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AV Fistula Surveillance Intervention — ESENeph MCQ

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ModerateHaemodialysisAV Fistula Surveillance InterventionESENeph

A 60-year-old man on haemodialysis via AV fistula has a successfully functioning access for 5 years. Routine surveillance Doppler shows flow rate of 450 mL/min (previously 800 mL/min) and there is a focal stenosis in the outflow vein. He is asymptomatic with adequate dialysis. Should intervention be performed?

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Correct answer: E — No – asymptomatic stenosis does not require intervention

Do not perform fistuloplasty solely for an asymptomatic Doppler-detected AV fistula stenosis. Current vascular-access guidance distinguishes clinical monitoring from surveillance: access-flow measurement and ultrasound findings are supplementary, and action should not be based only on surveillance abnormalities. Intervention is indicated when a radiologically significant stenosis is accompanied by clinical access dysfunction, such as cannulation difficulty, inability to achieve prescribed dialysis blood flow, prolonged post-needle bleeding, abnormal examination, arm swelling, thrombosis, or inadequate dialysis. This patient has a functioning AV fistula and adequate dialysis with no clinical indicators of dysfunction, so the correct management is continued clinical monitoring rather than pre-emptive intervention.

Reference: National Kidney Foundation KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update, published in AJKD 2020;75(4 Suppl 2):S1-S164. https://www.kidney.org/professionals/kdoqi/guidelines-and-commentaries/vascular-access