SVU 2025 Annual Conference Hemodialysis Session-SVU 2025 Annual Conference Hemodialysis Session

Video Transcription

Video Summary

The conference session addresses advancements and best practices in vascular access for hemodialysis patients. Melissa Warren introduces innovative access solutions, focusing on autogenous and non-autogenous configurations, including traditional open surgical arteriovenous fistulas (AVFs) and grafts (AVGs), as well as the emerging endovascular or percutaneous creation of AVFs (endo-AVFs). She discusses devices like Ellipsys (Medtronic) and WavelinQ (BD), both FDA-approved for creating endo-AVFs with different procedural requirements and anatomical considerations. Warren also highlights a novel external cage device (VASQ) aimed at reducing vessel stress and improving fistula durability. She emphasizes the critical importance of patient-specific planning considering vessel anatomy and life-long access options.<br /><br />Matt Allen follows with best practices for accurate ultrasound assessment of AVFs and AVGs, stressing thorough preparation by reviewing patient history, dialysis status, and access type. He underscores adherence to lab protocols, professional guidelines (SVU PPGs), and accreditation standards to ensure consistent, high-quality imaging. Allen details imaging techniques for inflow, anastomosis, outflow, and central veins, emphasizing the importance of comprehensive hemodynamic evaluation, including velocity measurements, flow volumes, and depth to assist in clinical decision-making.<br /><br />Mary Beth Georges elaborates on differentiating normal versus pathological findings in dialysis access assessment. She reviews hemodynamic changes post-access creation, including arterial flow patterns, venous arterialization, and flow alterations such as steal syndrome. Georges offers practical tips for evaluating stenosis, aneurysms, pseudoaneurysms, and central venous issues. She stresses the “rule of six” for fistula maturity (≥6 mm diameter, ≤6 mm depth, ≥600 mL/min flow) and highlights the need for detailed documentation tailored to patient anatomy to guide management.<br /><br />In summary, the session provides comprehensive insights into modern vascular access options, detailed ultrasound imaging protocols, and precise assessment criteria critical for optimizing hemodialysis access outcomes and patient care.

Keywords

vascular access

hemodialysis

arteriovenous fistulas

endovascular AVF creation

Ellipsys device

WavelinQ device

ultrasound assessment

fistula maturation criteria

stenosis evaluation

patient-specific access planning