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End-stage kidney disease patients who are candidates for surgical arteriovenous fistula creation commonly experience obstacles to a functional surgical arteriovenous fistula, including protracted wait time for creation, poor maturation, and surgical arteriovenous fistula dysfunction that can result in significant patient morbidity. The recent approval of two endovascular devices designed to create a percutaneous arteriovenous fistula enables arteriovenous fistula creation to be placed in the hands of interventionalists, thereby increasing the number of arteriovenous fistula providers, reducing wait times, and allowing the patient to avoid surgery. Moreover, current studies demonstrate that patients with percutaneous arteriovenous fistula experience improved time to arteriovenous fistula maturation. Yet, in order to realize the potential advantages of percutaneous arteriovenous fistula creation within our hemodialysis patient population, it is critical to select appropriate patients, ensure adequate patient and dialysis unit education, and provide sufficient instruction in percutaneous arteriovenous fistula cannulation and monitoring. In this White Paper by the American Society of Diagnostic and Interventional Nephrology, experts in interventional nephrology, surgery, and interventional radiology convened and provide recommendations on the aforementioned elements that are fundamental to a functional percutaneous arteriovenous fistula.

Ultrasonography is increasingly being used in the practice of nephrology, whether it is for diagnosis or management of acute or chronic kidney dysfunction, until progression to end-stage kidney disease, including preoperative assessment, access placement, and diagnosis and management of dysfunctional hemodialysis access. Point-of-care ultrasounds are also being used by nephrologists to help manage volume status, especially in patients admitted to the intensive care units, and more recently, for guiding fluid removal in the outpatient dialysis units. Fundamental knowledge of sonography has become invaluable to the nephrologist, and performance and interpretation of ultrasound has now become an essential tool for practicing nephrologists to provide patient-centered care, maximize efficiency, and minimize fragmentation of care. This review will address the growing role of ultrasonography in the management of a patient with CKD from the point of initial contact with the nephrologist throughout the spectrum of kidney disease and its consequences., (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

The population of patients with end-stage renal disease (ESRD) in the United States is progressively increasing, with hemodialysis (HD) as the major mode of renal replacement therapy. National guidelines recommend increasing the use of arteriovenous fistulae (AVF) in both incident and prevalent hemodialysis patients. Pre-operative vascular mapping prior to the surgical creation of an AVF is now considered standard of care and may be helpful in achieving these goals. This manuscript focuses on the advantages and limitations of the various imaging techniques currently available for vessel mapping including physical examination, ultrasonography, angiography (iodinated contrast vs. CO 2 ), and magnetic resonance angiography (MRA), with specific suggestions for clinical use., (© 2017 Wiley Periodicals, Inc.)

Pseudoaneurysms frequently develop at cannulation sites in arteriovenous grafts. The current treatment options are either open surgical revision or endovascular placement of stents to cover the pseudoaneurysm. The ideal treatment option needs to be individualized based on the clinical assessment and the involved risks with the procedure. The safety of cannulating the dialysis access through a stent graft for hemodialysis has not been conclusively established and needs to be avoided when possible. This case report emphasizes the hazards associated with cannulation of stent grafts, including stent fracture and leakage of blood into the surrounding tissue with recurrence of pseudoaneurysm.