Pre and Post Op Percutaneous AV fistula Assessment–What Should We Evaluate?

Introduction/Patient Description

Two percutaneous systems are FDA approved for dialysis access creation. Both rely on an arteriovenous (AV) connection flowing through the perforator vein to the superficial venous system. Vascular lab studies in preparation for these new fistulas, and to troubleshoot problems, have unique requirements not standardly performed by vascular labs. We report on preoperative mapping and postoperative evaluation of percutaneous arteriovenous fistulas (AVF’s).

Methods

Duplex imaging criteria have been established for preoperative assessments for percutaneous AVF’s. Postoperative assessments are unique because of variable anastomotic location and multiple outflow channels.

Results

Both new systems require the presence of a patent perforator vein of adequate size, and proximal forearm arteries of adequate size, without significant calcification. One system also requires assessment of the deep venous system of the arm and forearm. Postoperative assessments require standard measurements of outflow veins in addition to volume flow in the feeding artery and each outflow venous segment. We’ll show examples of these assessments with device specific criteria.

Conclusion/Discussion

High quality vascular lab studies are essential to dialysis access practices. We’ll share new vascular lab procedures to support the emerging technology of percutaneous fistula creation procedures.

 

Categories Abstracts