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Identifying Flow Dominance Flow dominance is important information for the physician to know when considering endoAVF. To assess flow dominance, rotate the ultrasound probe to the axis on the proximal arm where the perforator is identified (see Figure 11). Blood flow predominantly travels to the larger outflow vein in line with the perforator configuration.

Figure 11 – Flow Dominance

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Arterial Inflow Arterial inflow is assessed just above the crease of the elbow. The sonographer should use the ultrasound probe to locate and measure the brachial artery, which must measure ≥2 mm in diameter for the patient to be a candidate for endoAVF (dual catheter system); and also measure the paired brachial veins as these can also be potential access points (see Figure 12).

Figure 12 – Locate and Measure the Brachial Artery

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