Vascular Guidebook 2

AV ACCESS CASE EXAMPLES The use of TTFM and HE-US is useful during the creation of AV-fistulas and also during flow modulation after initial fistula creation. Shown below are some case examples from the use of intraoperative guidance and quality control using Medistim systems. 9.3 Radiocephalic AV fistula creation Normal intraoperative situation of an AV-fistula, In this case, high-resolution ultrasound served as first completion control to detect any problem in the anastomosis. The system is set in Color mode and the image shows an open arteriovenous anastomosis. As a tool to predict AV fistula maturation, TTFM was performed. The flow was considered high enough for a successful maturation. 9.4 Radiocephalic AV fistula thrombus AV-prosthesis graft with a dysfunction. The reason for the dystunction was an atheromatous thrombus close to the wall of the prosthesis graft in the region of the puncture sites. 9.5 Radiocephalic AV fistula obstruction This ultrasound image with CFM shows how a thrombus is occluding a native arteriovenous fistula.