الفهرس 
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Abstract
Hemodialysis is one of the most efficient treatment as renal replacement therapy in ESKD, its effectiveness rely greatly on the adequacy of vascular access applied.
Different types of vascular access for hemodialysis are reported in literature and used in clinical practice according to the different patients (individualized), CVC is beneficial in cases of AKI where emergent dialysis is needed. Yet, it has high infection rates, significant thrombotic events.
AVG is remains a second line treatment in cases where AVF could not be created because of inadequate superficial veins, it has the advantages of short time required for maturation, and first use, much easy to cannulate. However, it has signfifant high infection rates, and incidence of stenosis /thrombosis is considerably higher than nAVF.
Therefore, native arterio-venous fistula remains the preferred vascular access used for hemodialysis (when available to create). Once it reaches maturation, it can be used for decades, it has remarkable fewer rate of complications, more patient compliance.
Nevertheless, Delayed maturation and primary failure of the nAVF remains one of the most challenging drawbacks of the use of AVF in hemodialysis, where its incidence ranging form 20-60% form all AVF created, which is a relatively high incidence. Which also affecting the health related quality of life and long term survival of the CKD patient on hemodialysis.
In our study we evaluate the role of US and CDUS for accurate evaluation of AVF, ultrasonography has the advantage of being non-invasive technique, non-ionizing radiation, real- time examination, could provide morphological and functional evaluation of the fistula pre and post-operative.
So. US and CDS (along with good clinical examination) are of utmost role in evaluation of the AVF which has role as pre-operative assessment to evaluate state of upper limb vasculature regarding artery and vein diameter, any anatomic alteration, and could provide great information regarding early predictors of AVF maturation , and early detection of complication, for early salvaging procedures.
Section 2: Conclusion
US and CDS is a useful tool of evaluation of AVF, pre-operative vein diameter and early blood flow measurement could be a predictive factors of AVF maturation.