Society for Vascular Surgery

View all recommendations from this society

Released January 29, 2015

Avoid routine ultrasound and fistulogram evaluations of well-functioning dialysis accesses.

Unfortunately, angioaccess for hemodialysis fails at a high annual rate. Therefore, it is appropriate to evaluate access sites with an ultrasound test whenever they appear to be malfunctioning. However, this is only necessary if the dialysis center notices unusual function on the machine (flow rates <300 or >1000, recirc >10%), abnormal bleeding after dialysis, or other clinical indicators such as enlarging pseudoaneurysm, pain, and/or suspected graft infection.

Under some circumstances, a fistulogram may be required. However, these invasive procedures have slight risks and are more costly than ultrasound studies. Therefore, they should not be performed routinely but only when clinically indicated and usually after a confirmatory ultrasound test. Performing ultrasounds at set intervals when the function of the access is normal is not needed.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Society for Vascular Surgery (SVS) formed a task force to gather initial recommendations for a list of procedures that should not be performed, performed rarely or performed only under certain circumstances. These draft recommendations were then sent to the Public and Professional Outreach Committee, which refined them before presenting them to its reporting council, the Clinical Practice Council. The Council reviewed the citations and ensured all recommendations aligned with SVS Clinical Practice Guidelines before submitting them to the Executive Committee of the SVS Board of Directors for approval. You can review the society’s conflict of interest and disclosure policy at


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Murphy EA, Ross RA, Jones RG, et al. Imaging in Vascular Access. Cardiovasc Eng Technol. 2017;8(3):255-272. doi:10.1007/s13239-017-0317-y

Gallieni M, Hollenbeck M, Inston N, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults [published correction appears in Nephrol Dial Transplant. 2020 Oct 1;35(10):1824] [published correction appears in Nephrol Dial Transplant. 2020 Dec 4;35(12):2203]. Nephrol Dial Transplant. 2019;34(Suppl 2):ii1-ii42. doi:10.1093/ndt/gfz072

Schmidli J, Widmer MK, Basile C, et al. Editor’s Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757-818. doi:10.1016/j.ejvs.2018.02.001

AIUM Practice Parameter for the Performance of Vascular Ultrasound Examinations for Postoperative Assessment of Hemodialysis Access. J Ultrasound Med. 2020;39(5):E39-E48. doi:10.1002/jum.15262