ABC | Volume 112, Nº6, June 2019

Statement Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(6):809-849 Figure 14 – Measurement of the distance between the brachial artery and basilic vein before the creation of alternative arteriovenous fistulas. BASILIC BRACHIAL 5.4.3. Causes and Types of Failures (Autogenous and Prosthetic) 74,76,79,82 • Arterial: diabetes mellitus and significant atheromatosis. • Venous: fibrosis. • Anastomosis site: turbulence and intimal hyperplasia. • Significant escape through tributary veins. • Steal phenomenon, in which retrograde flow is found in the radial artery distal to AVFH (Figure 15). • Pronounced tortuosities. • Intimal hyperplasia (valves). • Thrombosis (dissection by puncture). • Idiopathic: puncture and surgical technique. • Significant stenosis with V2/V1 ≥ 4 (if ≥ 2 indicates stenosis > 50%; angioplasty is recommended in case of clinical and/or hemodynamic abnormalities associated). • Occlusion. • Aneurysm, dilation due to prosthesis degeneration and pseudoaneurysm. • Infection. • Hematoma, seroma, and lymphocele. 5.4.4. Examination Limitations Inexistent, with rare exceptions in highly significant edemas, fibrotic scars, and presence of orthopedic devices. 5.4.5. Suggestions to Elaborate the Report and Conclusion 1. Examination before the procedure (Table 20): • Report deep and superficial venous thrombosis; abnormalities in the arterial system; and anomalous anatomic changes, such as the number of vessels, paths, and forearm vessels that continue in the arm • Inform the measurements of calibers and proper flows. Table 19 – Objectives of arteriovenous fistulas for proper hemodialysis (95%) 77 ● Vascular diameter: > 4 mm ● Flow volume: > 500 ml/min ● Maturation time: > 30 days ● Diameters < 3mm and flow volume < 400 ml/min = high probability of failure ● Vessel diameter should increase with time 833