In chronic kidney patients who are on dialysis, access to veins is an ever increasing problem. It is important to extend the functional life of each access because the sites available for dialysis are limited and patients are dependent on dialysis for survival. A periodic surveillance venography of the fistula can help to increase the longevity of the graft/fistula.
The incidence of renal diseases is increasing because several patients require dialysis for a long period of time. The ideal hemodialysis access is an endogenous AV fistula or graft creation.
Graft surveillance is an established concept by National Kidney Function- Dialysis Outcome Quality Initiative (NKF-DOQI) and involves regular assessment of flow through the graft. If the flows through the graft are less than 400-600 ml/min, then venography of the graft is recommended to know the inflow and outflow through the graft. Any obstruction to inflow or outflow can be corrected using interventional radiology techniques like balloon dilatation (angioplasty) or stenting of narrowed portion of the vessel.
In many cases, if the fistula or graft does not mature or function optimally or there is an issue of multiple failed grafts, in that case, a semi-permanent solution of inserting a tunnelled hemodialysis catheter is considered. Through this catheter, dialysis can be performed for several months, till a permanent graft or fistula can be created and it matures (requires a minimum of 6 weeks). All these procedures are day care and the patient can be discharged on the same day.