ACR Appropriateness Criteria® Dialysis Fistula Malfunction


Mikhail C. Higgins, Boston University School of Medicine, Boston, Massachusetts. Electronic address:
Matthew Diamond, Research Author, Boston Medical Center, Boston, Massachusetts.
David M. Mauro, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Baljendra S. Kapoor, Panel Chair, University of Michigan, Ann Arbor, Michigan.
Michael L. Steigner, Panel Chair, Brigham & Women's Hospital, Boston, Massachusetts.
Nicholas Fidelman, Panel Vice-Chair, University of California San Francisco, San Francisco, California.
Ayaz Aghayev, Brigham & Women's Hospital, Boston, Massachusetts.
Murthy R. Chamarthy, Vascular Institute of North Texas, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging.
Julien Dedier, Boston Medical Center, Boston, Massachusetts, Primary care physician.
Ellen D. Dillavou, WakeMed Hospital System, Raleigh, North Carolina; Society for Vascular Surgery.
Mila Felder, Advocate Christ Medical Center, Oak Lawn, Illinois; American College of Emergency Physicians.
Susie Q. Lew, George Washington University, Washington, District of Columbia; American Society of Nephrology.
Mark E. Lockhart, University of Alabama at Birmingham, Birmingham, Alabama.
Jeffrey J. Siracuse, Boston University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery.
Karin E. Dill, Specialty Chair, Emory University Hospital, Atlanta, Georgia.
Eric J. Hohenwalter, Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin.

Document Type

Journal Article

Publication Date



Journal of the American College of Radiology : JACR








AUC; Appropriateness Criteria; appropriate use criteria; central venous stenosis; dialysis access dysfunction; fistulography; nonmaturing fistula; thrombosed arteriovenous fistula; vascular steal syndrome


The creation and maintenance of a dialysis access is vital for the reduction of morbidity, mortality, and cost of treatment for end stage renal disease patients. One's longevity on dialysis is directly dependent upon the quality of dialysis. This quality hinges on the integrity and reliability of the access to the patient's vascular system. All methods of dialysis access will eventually result in dialysis dysfunction and failure. Arteriovenous access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfunction, and infectious complications. The restoration of any form of arteriovenous access dysfunction may be supported by diagnostic imaging, clinical consultation, percutaneous interventional procedures, surgical management, or a combination of these methods. This document provides a rigorous evaluation of how variants of each form of dysfunction may be appraised and approached systematically. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.