Preoperative Vascular Mapping With Doppler Ultrasound—A Standardized Protocol in Vascular Access for Hemodialysis

António Gomes; Ana Germano; Fernando Domingos; Vitor Nunes

doi:10.2309/JAVA-D-20-00016

Article Contents

Highlights
Abstract
Introduction
Institutional Setting
Literature Review
Standardized Doppler Ultrasound Evaluation—Our Protocol
Discussion
References

Editorial Type:

Article Category: Research Article

Online Publication Date: 05 Nov 2020

Preoperative Vascular Mapping With Doppler Ultrasound—A Standardized Protocol in Vascular Access for Hemodialysis

MD,

MD, PhD,

MD, PhD, and

Page Range: 58 – 63

DOI: 10.2309/JAVA-D-20-00016

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Abstract

The role of Doppler ultrasound (DU) has become progressively established over the last 15 years as a complement to preoperative assessment of vascular access. However, the literature is scarce regarding DU protocol and standardization. In this paper we describe our protocol for systematic upper limb vascular mapping with DU for preoperative assessment in vascular access for hemodialysis: setup and patient positioning; anatomic and hemodynamic parameters to assess; sequence and technique of assessment; and standardized report in a multidisciplinary scenario for surgical decision.

Keywords: Doppler ultrasound; vascular access; haemodialysis; surgical planning; clinical protocols

Figure 1.

Patient positioning for Doppler ultrasound.

Figure 2.

A classical (left) cephalic-subclavian confluent (arrows). M = medial; L = lateral.

Figure 3.

Different superficial vein patterns at the elbow. (a) The classical M-shaped pattern; (b) The W-shaped pattern (note the accessory basilic vein); (c) the Y-shaped pattern.

Figure 4.

(a) Pressure applied to the probe results in a collapsed vein (arrows). Special care should be taken when applying the probe to superficial veins: (b) noncollapsed transverse vein section to measure vein diameter.

Figure 5.

The Doppler sample volume is carefully set to fill the artery lumen. This is of the utmost importance for a reliable estimation of average blood speed. A correct sample volume and a correct Doppler angle (white circle) are the cornerstones of built-in software brachial artery flow computation.