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If the perforator diameter is confirmed to be ≥2 mm, document findings per facility requirements (Table 3) and continue screening to identify if the patient meets the additional qualifications for dual catheter system endoAVF. 15

Table 3 – Perforator Measurement

Source: BD, Bard. WavelinQ™ 4F Vessel Mapping Sheet. BD-12525v2. https://wavelinq.bd.com/wordpress/wp-content/uploads/2020/03/BD-12525v2-WavelinQ-4F- Vessel-Mapping-Sheet.pdf. Accessed October 10, 2021.

A tortuous, or incompetent, perforator has a C-shape curve. Patients with this type of complex perforator may not be ideal candidates for dual catheter system endoAVF.

Figure 9 – Example of a Tortuous Perforator

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If a tortuous perforator is observed, the sonographer should document the assessment and discuss it with the physician. 14 If during screening of the cephalic or basilic vein to the proximal arm a perforator is not observed, it means that there is no communication between the deep and superficial veins at the site where a fistula would be created. This is an indication the patient is not a candidate for endoAVF procedure utilizing the dual catheter system. 14 If the perforator is not evident during screening of the cephalic or basilic vein to the proximal arm, the patient is not a candidate for endoAVF procedure utilizing the dual catheter system (see Figure 10). 14

Figure 10 – Example of Perforator that Does Not Meet Criteria for endoAVF Utilizing Dual Catheter System

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