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Vascular > Chapter 30: Hemodialysis Access Grafts and Fistulae > Flashcards

Chapter 30: Hemodialysis Access Grafts and Fistulae Flashcards

1
Q

The location where the artery and vein are connected or where the graft is connected to the artery or vein

A

anastamosis

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2
Q

A balloon-like dilation of the blood vessel of the artery or vein

A

aneurysm

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3
Q

a deliberate connection between a native artery and vein constructed with an end-to-end anastamosis, created to allow for hemodialysis acccess

A

arteriovenous fistula

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4
Q

a type of hemodialysis access that uses an interposing bicompatible synthetic tube connecting an artery to a vein to allow for hemodialysis access

A

arteriovenous graft

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5
Q

the audible sound caused by the high pressure pressure arterial flow of blood passing through a low-resistance venous structure such as an arteriovenous fistula or graft

A

bruit

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6
Q

a means to artificially cleanse the blood by removing by-products, waste, and fluid in patients with end-stage renal disease via a dialyzer machine

A

hemodialysis

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7
Q

also known as vascular access, is a surgically created connection between an artery and a vein to allow for the removal of toxic by-products from the blood via hemodialysis

A

hemodialysis access

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8
Q

a minimally invasive method for arteriovenous fistula created by means of readiofrequency energy that combines heat and pressure

A

percuteaneous fistula

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9
Q

a balloon-like outpuching of the access, often associated with repeated needle puncture, leading to loss of structural integrity

A

pseudoaneurysm

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10
Q

the palpable sensation of an arteriovenous fistula or graft caused by the high pressure arterial flow of blood passing through a low-resistance venous structure

A

thrill

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11
Q

posterior radial artery to cephalic vein

A

snuff box fistula

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12
Q

radial artery to cephalic vein

A

Brescia-Cimino fistula

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13
Q

Normal AVF characteristics

A

anechoic flow lumen free of intraluminal echoes
lumen fills wall to wall with color flow
low-resistive pulsatile flow without focal velocity elevation

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14
Q

Stenotic AVF characteristics

A

intraluminal echos
thickened walls
reduced flow lumen
disturbed color-flow patterns
elevated velocities in region of stenosis

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15
Q

occluded AVF characteristics

A

intraluminal echogenicity
loss of flow lumen
no flow
absent Doppler signal

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16
Q

The National Kidney Foundation Kidney Dialysis Outcomes Quality initiative recommends ____% of future hemodialysis access be constructuted with autogenous AV access

A

50

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17
Q

Goal of AVF or AV graft creation

A

provide repeared hemodialysis access while maintaining a low frequency of reinterventions and complication rates

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18
Q

An autogenous fistula should be created as _____ as possble in ______ arm.

A

distal
nondominant

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19
Q

Why is autogenous AVF creation the preferred finrst line therapy?

A

superior patency rates
lower rate of complication

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20
Q

surgically created anastamosis between any artery and vein

A

native AVF

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21
Q

Thr room should be kept comfortably warm to prevent _____

A

vasospasms

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22
Q

Acceptable diameter of an artery for fistula

A

> 25 mm

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23
Q

Why are arteries interrogated before AV procedure?

A

calcifications
intimal thickness
stenosis
compliance

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24
Q

The quality of the arterial wall determines the ____ of the artery to dilate and accomodate increased flow

A

capacity

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25
Q

Where is atherosclerosis most often observed in the upper extremities?

A

subclavian artery

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26
Q

In the diabetic patient where can you find atherosclerosis?

A

radial and ulnar arteries

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27
Q

Focal narrowing of vein at any level may prevent ______

A

fistula maturation

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28
Q

The basicilic vein needs to be greater than ___ cm in legtnth with adequate diameters for transposition

A

10

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29
Q

central venous occlusion doppler characteristics

A

loss of phasic flow, presence of a continuous wavefore

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30
Q

Routine unilateral upper extremity mapping should take __-__ minutes

A

30
40

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31
Q

Contraindications to upper extremity mapping

A

local infections
obtrustive dressing
open wounds
restricting patient positioning

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32
Q

The radial, ulnar, and brachial arteries need to have an arterial diameter greater than ___ mm.

A

20

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33
Q

bright white echoes along or within vessel walls

A

calcifications

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34
Q

Normal arterial Doppler spectral waveform

A

high resistive with a rapid upstroke, sharp peak, and low diastolic flow

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35
Q

Favorable diameter for AV creation

A

2.5 cm

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36
Q

Venous Doppler criteria from central veins

A

respiratory phasicity
cardiac pulsatility
augmentation

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37
Q

The goal of hemodialysis access evaluation

A

provide a durable means for vessul cannulation that is located distally in the limb; allows the option for creating of a more proximal access should distal AVF fail

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38
Q

frequently performed fistula; involves mobilizing distal cephalic vein at wrist and anastamosing it to distal radial artery in an end-to-side configuration

A

Brescia-Cimino fistula

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39
Q

connecting posterior branch of radial artert to cephalic vein

A

snuffbox fistula

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40
Q

requires vein to be transposed and juxtaposed to a distal artery (radial or ulnar) in order to creat AVF

A

medial location of forearm basilic vein

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41
Q

Most common upper arm access

A

brachial artery to cephalic vein fistula; created at or just distal to the antecubital fossa

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42
Q

Possible sites for arterial infolow of basilic transposition

A

brachial, radial, ulnar

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43
Q

Lower extremeity hemodialysis access sites

A

common femoral artery
superficial femoral artery
transposed great saphenous of femoral veinFi

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44
Q

Fistula maturation takes place __-__ weeks after creation of fistula

A

10-12

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45
Q

defined by a dilated cein, ,palpable thrill, audible bruit

A

Matured fistula

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46
Q

Flow rates are greater than ___ mL/min for fistulas that failed to mature

A

500

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47
Q

You should change system presets to ____ flow setting for hemodialysis access examination

A

high flow

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48
Q

Inflow artery supplying dialysis access waveform

A

low-resistance waveform with constant antegrade flow throughout cardiac cycle

49
Q

volumetric flow calculation

A

time average velocity x area x 60

50
Q

Hemodilaysis access examiantion takes about __-__ minutes

A

30
45

51
Q

hypoechoic to anechoic depending on age

A

thrombosisb

52
Q

bright white relfectirs within vessel walls

A

calcifications

53
Q
A
54
Q

valve protruding into vessel lumen; potentially a site for initmal hyperplasia formation

A

incompetent valve

55
Q

Well function fulsta demonstrate PSV between ____-___ cm/s

A

150
300

56
Q

EWll functioning fistulas demonstrate an EDV of ____-____ cm/s

A

60
200

57
Q

Stenosis may be present if PSV is less than ___ cm/s

A

50

58
Q

inflow artery blood flow characteristics

A

low resistance flow
increased PSC (30-100 mL/min)
pulsatile flow in outflorw vein

59
Q

Expected flow through fistula

A

marked spectral broadening, continuous forward diastolic flow; high velocity

60
Q

Account for ___% access-related complications

A

anastomotic and vein or graft stenosis

61
Q

echogenic intraluminal lesions; luminal flow reduction on B-mode

A

outflow vein stenosis

62
Q

high resistance signal, absent flow lumen, intraluminal echogenic thrombus

A

fistula or graft occlusion

63
Q

Normal flow volume in a fistula

A

greater than 800 mL/min

64
Q

mild-to-moderate stenosis in fistula

A

500-800 mL/min

65
Q

severe stenosis in fistula

A

less than 500 mL/min

66
Q

retrograde flow in artery distal to fistula or graft anastamosis

A

steal phenomenon

67
Q

Occurs in 75-90% of patients after access creation

A

steal phenomenon

68
Q

based on fluid dynamics, low resistance outflow vein draws antegrade flow from inflow artery and in addition “steals” retrograde flow from distal artery

A

steal phenomenon

69
Q

symptoms of steal phenomenon

A

pain during hemodialysis
rest pain
weakness
paresthesias
tissue loss if advanced

70
Q

cause of steal phenomenon

A

problem with high flow through fistula, insufficient distal collateral circulation, inflow arterial occlusive disease

71
Q

Significant steal syndrome if digital pressure is less than ___ mm Hg

A

40

72
Q

Significant steal syndrome if digital brachial pressure index is less than ___

A

0.6

73
Q

novel minimally invasive percuteaneous AVF creation devices

A

EndoAVF

74
Q

use magnetic catheters and radiofrequency energy to create in vivo anastomosis

A

EndoAVF

75
Q

For an endoAVF an adequate perforating vein is needed at the ______

A

antecubital fossa

76
Q

The WavelinQ EndoAVF system requires two access sites, the _______ and the ______ in the distal forearm

A

brachial artery
radial or ulnar vein

77
Q

The Ellipsys Vascular Access System requires one single point of access, through a perforating vein into the ______

A

radial artery

78
Q

The goal of the Kidney Dialysis Outcomes Quality Initiative was to increase and expand the creation of which of the following?
a. prosthetic hemodialysis access grafts
b. autogenous hemodialysis access fistulae
c. lower extremity hemodialysis access
d. central venous port access

A

b

79
Q

What is the most common cause of maturation failure of dialysis access fistulae?

A

small or suboptimal veins

80
Q

Which of the following should be included during the physical examination for preoperative artery mapping for dialysis fistula creation?
a. bilateral arm blood pressure measurements
b. pulse examination of brachial, radial, and ulnar arteries
c. Allen’s test for palmar arch assessment
d. all of the above

A

d

81
Q

Which of the following is NOT a finding suggestive of a central venous stenosis or occlusion?
a. are edema
b. prominent chest wall veins
c. painful, cool, pale hand
d. presence of arm collaterals

A

c

82
Q

Which of the following describes the proper patient positioning for upper extremity venous evaluation before fistula creation?
a. supine with arm elevated
b. supine or sitting with arm dependent
c. standing with weight held in arm to be examined
d. Trendelenburg with feet elevated

A

b

83
Q

With what does standard protocol for evaluation of the upper extremity arteries and veins for fistula creation begin?

A

arteries of nondominant arm

84
Q
A
85
Q

All Doppler studies should be performed at an angle of ____ or less, even if actual velocities are not recorded to achieve adequate Doppler signals.

A

60 degrees

85
Q

What is the acceptable minimum vein diameter for favorable fistula creation?

A

2.5 mm

86
Q

Which of the following should venous Doppler signals from central veins NOT display?
a. respiratory phasicity
b. cardiac pulsatility
c. augmentation
d. continuous flow

A

d

87
Q

The most common upper arm access is made between the cephalic vein and which artery?

A

brachial artery

87
Q

What is a type of fistula created by connecting the posterior branch of the radial artery to the cephalic vein?

A

snuffbox fistula

88
Q

Approximately how long should it take an autogenous fistula to mature?

A

8-12 weeks

89
Q

During evaluation of the upper extremity either before or after fistula creation, the examination room should be kept warm to avoid what?

A

vasospasm

90
Q

Which of the following is NOT included in a physical examination of a patient with a current AV fistula?
a. assessment of thrill
b. assessment for edema or redness
c. bilateral radial blood pressures
d. visual inspection for focal dilations and collateral veins

A

c

91
Q

During duplex assessment of the hemodialysis fistula, what should Doppler settings be adjusted to detect?

A

high flow

92
Q

Which of the following describes how volumetric flow is calculated?
a. time average velocity/PSV
b. time average velocity x area x 60
c. time average velocity x vessel diameter
d. PSV-EDV/PSV

A

b

93
Q

What can remaining valve leaflets that project into the lumen of a fistula become a source for?

A

pseudoaneurysm development

94
Q

A patient presents to the vascular lab for follow up evaluation of a dialysis fistula. Velocities within the fistula are 40 cm/s. What are these findings consistent with?

A

inflow artery stenosis

95
Q

What should be the approximate normal volume flow in a fistula?

A

800 mL/min

96
Q

The goal of arteriovenous access is to provide long-term hemodialysis access with a ____ frequency of reintervention and a low _____ rate.

A

low
complication

97
Q

______ access has been the preferred first-line therapy because is has superior patency rates and lower complication rates compared to ________

A

autogenous AVF
prosthetic grafts and tunneled catheters

98
Q

AV fistulas have higher long-term patency rates; however, they suffer from lower _______ rates and higher early _____ rates.

A

maturation
AVF thrombosis

99
Q

Placement of central venous catheters, pacemakers, defibrillators, or prior mastectomy with lymph node dissection may _____ the creation of an arteriovenous hemodialysis fistula.

A

preclude

100
Q

AV fistula creation is usually first attempted in the ______ upper extremity as far _____ as possible

A

non-dominant
distal

101
Q

Atherosclerosis is uncommon in the upper extremities, but when it occurs, it most commonly affects the _____ artery.

A

subclavian

102
Q

To maximally dilate the veins, a(n) ______ may be used either just below the antecubital fossa for forearm veins or at the axillary level for upper arm veins

A

tourniquet

103
Q

Patency of veins should be confirmed both with transducer _____ and spectral Doppler waveforms.

A

pressure

104
Q

A dilated, easily palpable, usable fistula with a flow rate of greater than 350 cc/min defines a fistula that has _____

A

matured

105
Q

A partially or noncompressible vein suggests the presence of an occluding ______ within the vein lumen, making it ______ as an autogenous conduit.

A

thrombus
unusable

106
Q

A Brescia-Cimino fistula is the most frequently created fistula and involves the ______ vein and the _____ artery at the wrist.

A

cephalic
radial

107
Q

Because of its deep location, the ______ vein requires that is be transposed and juxtaposed to a distal artery to create an AV fistula.

A

basilic

108
Q

While performing duplex assessment either preoperatively or after hemodialysis fistula placement, the examination room should be kept warm to avoid ______

A

vasospasm

108
Q

To assess for edema, redness, presence of collateral veins, rotation of access sites, and focal dilations, the arm should be _______ by the technologist before duplex assessment.

A

physically inspected

109
Q

Presence of perigraft masses, pseudoaneurysms, stenotic valves, and intimal flaps should be assessed during _____ imaging evaluation of a dialysis fistula.

A

B-mode

110
Q

When stenosis is found, spectral Doppler velocities should be measured ____, _____, and _____ the area of interest.

A

proximal
distal
within

111
Q

When measuring volume flow rates of a hemodialysis fistula, the ______ is used and is best measured over ____ cardiac cycles to obtain an accurate calculation.

A

time average velocity
3-4

112
Q

As fistulas mature, they typically become tortuous and can become aneurysmal, thus requiring larger amounts of ___ to maintain proper skin contact over these surface irregularities

A

gel

113
Q

If a hemodialysis fistula has a volume flow measurement less than 500 mL/min, this would indicate ____ in the fistula.

A

stenosis

114
Q

When performing preoperative duplex evaluation for endovascular AVF creation, closer attention is paid to the ______ between the superficial and deep venous systems

A

tributaries

115
Q
A

Vascular (33 decks)

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