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Vessel Mapping Sonographers are vital in the AV access determination through accurately screening, documenting, and communicating results to the ordering physician to determine if patients are potential candidates for an endoAVF creation. Vessel mapping is a US procedure conducted by sonographers that gathers information about arterial and venous anatomy and is intended to provide critical preprocedure information to make a determination if the patient is an appropriate candidate for endoAVF. Vessel mapping consists of conducting a duplex ultrasound of patients’ veins and arteries i n the upper extremities. Duplex ultrasound allows the physician to select appropriate vessels for AV access based on luminal size and distensibility with manual occlusion of blood flow. 5 Depending on the physician’s order, sonographers can map the upper ex tremities entirely or perform a focused preprocedure mapping that concludes when vessels adequate for endoAVF creation are established. 12 Sonographers must take care with carrying out the procedure and be mindful of measurement errors due to skill competency, variance in interpretation, and patient factors (eg, patient temperature and/or hydration level may influence results). Candidate Screening and Patient Selection Individual and patient-centered endoAVF planning is essential and influenced by patient factors such as, medical status (ie, baseline health, stage of renal disease, life expectancy, comorbidities, mental health), anatomic considerations (eg, availability of suitable vessels), and history of hemodialysis using a different access method. Candidates for endoAVF must meet the standard screening for sAVF in addition to additional requirements for an endoAVF (dual catheter system) procedure (Table 1). Patients considered healthy enough to have a standard endovascular procedure and sAVF qualify for further assessment for endoAVF (dual catheter system). Candidates must also have a patent perforator that communicates between the superficial and deep veins. Lastly, candidates must have an adequate creation site with ulnar artery/vein or radial artery/ve in ≥2 mm in diameter. 13

Table 1 – Standard and Endovascular (Dual Catheter System) AVF Screening Standards

EndoAVF Screening (Dual Catheter System)

Screening Criteria

Standard AVF Screening

Good Inflow – Brachial artery >2 mm in diameter

Good Outflow – Superficial cephalic and basilic veins >2.5 mm in diameter without a flow limiting central venous stenosis

Does not have flow limiting central venous stenosis

Does not have upper extremity venous occlusion on same side as planned AVF creation

Adequate Target Creation Vessels – Ensure diameter of ulnar or radial artery and at least one ulnar or radial vein is ≥2 mm in diameter Presence of a Perforator – Perforator adequately communicates between deep and superficial veins Procedure Access – Ensure diameter of brachial artery and one vein (Ulnar, Radial, and/or Brachial) is ≥2 mm