Practical Step 9: Ultrasound-Guided Vascular Access Intervention
Why Does Hemodialysis Vascular Access
Need "Ultrasound Guidance"?
1. Detect Problems Earlier
Ultrasound can real-time display blood flow conditions, lumen morphology, and the degree of stenosis, helping to detect the following conditions at an early stage: stenosis (especially at the anastomosis), thrombosis, decreased flow velocity, intimal hyperplasia, and calcification or distortion of artificial blood vessels. Early screening can avoid emergencies such as “sudden inability to undergo dialysis”.
2. More Precise Intervention Process
Ultrasound provides key information throughout the interventional treatment: identifying the puncture site and direction; observing the positions of the guidewire and balloon; real-time monitoring of dilation effects; avoiding accidental entry into surrounding tissues or incorrect puncture of blood vessels, making the procedure safer and more successful.
3. Reduce Dependence on Contrast Agents
For patients with renal insufficiency, reducing the use of contrast agents is a form of protection in itself.
Typical Application Scenarios
I. Ultrasound-Guided Balloon Angioplasty for Stenosis
Preoperative Precise Assessment
– Stenosis Localization: Precisely measure the location, length, and severity of stenosis.
– Hemodynamic Assessment: Record the preoperative PSV ratio and blood flow volume.
– Path Planning: Select the optimal puncture approach and avoid important structures.
Intraoperative Real-Time Guidance
– Puncture Guidance: Real-time display of the puncture needle entering the target vessel.
– Guidewire Localization: Confirm that the guidewire passes through the stenotic segment and is located in the true lumen.
– Balloon Positioning: Precisely position the center of the balloon at the most severe part of the stenosis.
– Dilation Monitoring: Real-time observation of the disappearance process of the balloon “waist sign”.
Immediate Postoperative Assessment
– Morphological Assessment: Measure the postoperative vascular inner diameter.
– Hemodynamic Verification: Confirm that the PSV ratio is < 2.0.
– Complication Screening: Check for vascular laceration and hematoma formation.
Technical Advantages
– No radiation exposure
– Real-time visualized operation
– Immediate evaluation of treatment effect
– Significant reduction in the risk of complications
http://超声实操案例 | 超声引导下动静脉内瘘狭窄的PTA术 (Click to jump and view)
II. Ultrasound-Guided Thrombectomy
Thrombosis Assessment and Staging
Acute Thrombosis (hypoechoic): Suitable for pharmacologic thrombolysis
Subacute Thrombosis (isoechoic): Consider mechanical thrombectomy
Chronic Thrombosis (hyperechoic): Surgical thrombectomy may be required
Individualized Treatment Plans
Pharmacologic Thrombolysis:
Ultrasound-guided puncture into the thrombus
Real-time monitoring of thrombolytic drug distribution
Assessment of blood flow recanalization
Mechanical Thrombectomy:
Guidance for accurate positioning of thrombectomy devices
Monitoring of the thrombus removal process
Timely detection of vascular injury
Key Safety Monitoring Points
Thrombus embolism monitoring: Observation of distal blood flow
Vascular wall integrity: Examination for intimal injury
Blood flow recovery assessment: Confirmation of antegrade blood flow restoration
III. Ultrasound-Guided Catheter Insertion
Preoperative Vascular Assessment
Target Vein: Inner diameter ≥ 3 mm, free of thrombosis and stenosis
Puncture Path: Avoid vital structures such as arteries and nerves
Depth Measurement: Precisely calculate the puncture angle and depth
Real-Time Guidance Techniques
Out-of-Plane Technique: Display the entire length of the needle tract
In-Plane Technique: Real-time display of the needle tip position
Vascular Confirmation: Confirm the position by aspirating blood
Catheter Position Confirmation
Lumen Localization: Confirm that the catheter tip is in the target vessel
Blood Flow Verification: Color Doppler shows blood flow around the catheter
Function Test: Flushing test to confirm patency
http://超声实操案例 | 此“路”不通，另辟蹊径(Click to jump and view)
IV. Ultrasound-Guided Aneurysm Treatment
Selection of Treatment Options
Thrombin Injection: Indicated for pseudoaneurysms
Covered Stent Implantation: Indicated for true aneurysms with severe dilation
Surgical Operation: Indicated for giant aneurysms or those at risk of rupture
Key Points of Ultrasound Guidance
Puncture Path: Avoid normal blood vessels and nerves
Drug Distribution: Real-time observation of thrombin diffusion
Efficacy Evaluation: Confirm the absence of blood flow signals in the aneurysm cavity
Only when the vascular access is visible can we be more assured.
In the context of hemodialysis intervention, the SonoMaxx handheld ultrasound makes “visualized intervention” more portable and accessible.
It truly achieves: diagnosis as treatment, completion at the bedside, minimal invasiveness and repeatability, greater friendliness to patients, and higher efficiency for doctors. Enabling every dialysis patient to have a more stable, durable, and safe lifeline access.
With the continuous growth of the hemodialysis population and the increasing demand for access maintenance, ultrasound-guided interventional therapy is becoming a more precise, safer, and more efficient solution.
☛ Next Issue Preview | Seeing the Future in the New Era: The Intelligent Age of Ultrasound for Hemodialysis Access
When AI meets ultrasound and precision medicine becomes a reality—hemodialysis access management is ushering in a revolutionary breakthrough!
In the next issue, we will enter the concluding part of The Future of Ultrasound for Hemodialysis Access: New Technologies and Multidisciplinary Collaboration, and take you to look forward to the development of the field.