Vascular surgeon finds POCUS ideal for percutaneous AV fistula access

Dr Alexandros Mallios, vascular surgeon at the Institut Mutualiste Montsouris in Paris has been using ultrasound-guided percutaneous arteriovenous fistula access in patients undergoing haemodialysis. Dr Mallios says he believes point-of-care ultrasound (POCUS) should be the standard of care for planning, creating and puncture of vascular access in all patients.

“I work predominantly in haemodialysis, and a large part of my role is creating and preserving vascular access in patients who need chronic haemodialysis,” he explained. “Each time a patient comes in for haemodialysis, insertion of two needles through the skin is required to access the AV fistula and connect the patient to the dialysis machine.”

There are a number of challenges to successful cannulation, requiring accurate needle insertion to avoid hitting pre-existing haematomas, natural bifurcations and tortuosity of the veins, perforation of the vessel walls, or missing the fistula entirely.

The use of ultrasound to guide needle placement reduces these challenges, as well as the complications that can occur afterwards.

“In the last few years, we have been developing an ultrasound-guided percutaneous technique to create AV fistulae without cutting through the skin with a scalpel. With POCUS, the needle puncture can be achieved with absolute accuracy, and the entire procedure of fistula creation is completed without the need for x-rays or contrast injections. It would be impossible to carry out such a puncture without ultrasound guidance; you need to use two imaging planes during the procedure to properly visualise the relevant structures and avoid complications,” said Dr Mallios.

“I find our Fujifilm SonoSite ultrasound systems to be very easy to use for training, as they are simple and intuitive, with only a few buttons, allowing first-time users to navigate the device without being overwhelmed.”

Lead picture: Vascular surgeon Dr Alexandros Mallios is using POCUS to reduce discomfort for haemodialysis patients.

Published on page 6 of the February 2020 issue of RAD Magazine.