Which sites of the hemodialysis access graft should be Doppler interrogated?

• A. Any regions of flow disturbances or stenosis in graft
• B. Inflow artery only
• C. Outflow vein only
• D. Anastomotic regions only

Answer: (A)

Stenosis in a hemodialysis access graft can occur at multiple locations along the entire circuit, so Doppler interrogation must survey every potential site of flow disturbance. When evaluating an AV graft, examine the arterial inflow just before the graft, the graft lumen itself for focal narrowing, the venous outflow and its anastomosis, and the downstream outflow vein. This comprehensive approach detects stenosis wherever it can arise—at the inflow, within the graft, at the anastomoses, or in the outflow vein—since problems in any segment can compromise flow and dialysis adequacy. Using velocity measurements and waveform analysis across these sites helps confirm where stenosis is and guides management.