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Reference Document | Expert Consensus on Ultrasound Interventional Therapy for Hemodialysis Vascular Access in China (2024 Edition)

Abstract

This consensus aims to provide clinical physicians with standardized guidance for ultrasound-guided PTA procedures, offer a reference for healthcare administrators in conducting quality control, and promote the wide application and popularization of ultrasound technology in arteriovenous dialysis access.

Preoperative ultrasound assessment

Sequence for ultrasound assessment of autologous AVF
In the direction of blood flow along the internal fistula, successively evaluate the conditions of the inflow tract artery, the anastomosis site, the fistula vein all the way to the point where it joins the brachiocephalic vein to enter the subclavian vein or where the great saphenous vein joins the axillary vein.

AVG ultrasonic assessment sequence
In the direction of blood flow along the internal fistula, successively evaluate the conditions of the inflow tract artery, the arterial anastomosis, the entire segment of the graft, the venous anastomosis, the autologous outflow tract vein up to the point where it joins the brachiocephalic vein to enter the subclavian vein, or where the great saphenous vein joins the axillary vein throughout the entire vascular pathway.

Evaluation content
Blood flow volume, resistance index (RI), vascular morphology and structure (including vessel diameter, intima-media thickness, calcification status, vascular course and depth), stenosis location (including vessel diameter, length and peak systolic velocity ratio (PSVR), thrombus condition (including location, nature and amount of thrombus)

Ultrasound manifestations and assessment indicators of vascular stenosis
1.Blood flow: Under the condition of stable systemic hemodynamics, the natural blood flow of the autologous arteriovenous fistula (AVF) is less than 500 ml/min, and the natural blood flow of the arteriovenous graft (AVG) is less than 600 ml/min.
2.Vascular inner diameter: For veins, the inner diameter of local blood vessels ≤ 1.7 mm or the inner diameter of long segments of blood vessels ≤ 2.0 mm, with a length ≥ 20 mm; for arteries, the inner diameter ≤ 2.0 mm; for veins, if the inner diameter is between 1.8 and 2.0 mm or for arteries, if the inner diameter is between 2.0 and 2.5 mm, a comprehensive judgment needs to be made based on the patient’s clinical symptoms, abnormal signs, and the effectiveness of hemodialysis.
3.RI：RI>0.5；
4.PSVR：PSVR>4。

Indications and periods for PTA intervention

Indications for intervention
If the ultrasound assessment reveals that there is one or more areas of stenosis, occlusion or thrombosis in the autologous AVF or AVG, and the patient presents with any of the following one or more symptoms, it is recommended to consider performing PTA intervention.
1.Physical examination findings: The tremor of the internal fistula has significantly weakened or disappeared, while the pulsation has become more pronounced; abnormal results were observed in the arm elevation test and the pulsation enhancement test.
2.Abnormal blood flow: The pump-controlled blood flow during dialysis remained consistently below 200 ml/min.
3.Significant increase in venous pressure: Venous pressure ≥ 200 mmHg, or dynamic venous pressure during dialysis continuously ≥ 160 mmHg
4.Dialysis recirculation rate: Recirculation rate ≥ 15%
5.Decrease in dialysis adequacy: The index of attack adequacy (Kt/V) has decreased without a clear cause by more than 0.2
6.Extended bleeding time: After the dialysis treatment, the time required for stopping bleeding at the puncture site significantly increased (more than 20 minutes), and the influence of coagulation function and anticoagulants was excluded.
7.Increased difficulty in puncture: The puncture operation becomes more challenging due to poor venous filling.

Intervention timing
For those meeting the PTA criteria, they should be managed through the specific time surgery. Under the condition that the patient’s vital signs are stable and there are no surgical contraindications, the PTA surgery should be completed within one dialysis period.

PTA surgical procedure

Anesthesia method
It is recommended to use ultrasound-guided brachial plexus nerve block anesthesia.

Access selection
The fistula vein approach and the distal arterial approach are the most commonly used approaches for performing PTA surgery on AVF.
The artificial vascular approach and the autologous vein approach are the most commonly used approaches for performing PTA surgery via the AVG.

Surgical procedure
a. Ultrasound-guided puncture
b. Heparinization is carried out based on the patient’s condition.
c. Utilizing the ultrasound probe from multiple angles to understand the details of the lesion, display the shape of the lesion opening and the channel, and assist in the passage of the guide wire.
d. Balloon Dilatation
Non-compliant high-pressure balloons are the preferred choice for PTA surgery of arteriovenous dialysis access; for stubbornly narrow lesions, ultra-high-pressure balloons or cutting balloons can be selected. Special balloons can be chosen based on the access route to facilitate insertion.
The diameter of the balloon should be 1 to 2 mm larger than the inner diameter of the adjacent normal blood vessel; if the difference in inner diameters between the stenotic segment and the adjacent normal vessel is large or there is a thrombotic lesion, it can be gradually expanded; the length of the balloon should not exceed the length of the lesion by too much to avoid damaging the normal vessel.
For multi-site lesions, the dilation sequence in the reverse blood flow direction can be adopted, with priority given to relieving the stenosis of the outflow tract. The duration of a single balloon dilation is generally controlled within 30 to 60 seconds.
e.Postoperative hemostasis: compression hemostasis, purse-string suture, 8-shaped suture
f.Postoperative puncture care planning was carried out, and postoperative precautions were informed.

Standard for successful surgery

Technical success criteria
Self-vascularized arteriovenous fistula (AVF) blood flow ≥ 500 ml/min, AVG blood flow ≥ 600 ml/min; RI < 0.5; Residual stenosis rate at the lesion site < 30%, PSVR < 2

Clinical success criteria
The internal fistula tremor can be palpated and has recovered or significantly intensified; the dialysis was successful for two consecutive times after the operation, and the pump-controlled blood flow was ≥ 200 ml/min

Complication identification

Hematoma at the puncture site
Vascular spasm
Vascular dissection
Vascular rupture
Pseudoaneurysm
Acute thrombosis formation
Balloon rupture
Fracture of the guidewire and catheter

Thrombosis treatment of dialysis access

Drug thrombolysis, mechanical thrombectomy through aspiration, and open surgical thrombectomy methods

The application of ultrasound technology in other surgical procedures

If the retraction after balloon dilation exceeds 50%, if the stenosis recurs twice consecutively within a short period of time, if there is a severe dissection or pseudoaneurysm during the operation, etc., stent implantation can be considered, and covered stents are recommended. The clinical data of stent implantation under ultrasound guidance are not yet sufficient, so when choosing ultrasound as the guiding method, caution should be exercised.
Ultrasound-guided balloon-assisted maturation technique (BAM) is the first-line treatment for immature arteriovenous fistulas. When choosing the balloon size, caution should be exercised. In case of necessity, gradual dilation can be performed, and contingency plans for vascular rupture should be formulated.
PTA should be the initial treatment for cephalic arch stenosis (CAS). This procedure can be performed under the guidance of DSA or ultrasound. However, stent implantation for CAS is not recommended to be done under ultrasound guidance.
For high-flow arteriovenous fistulas that cause dialysis access-related extremity ischemia syndrome or high-output heart failure, it is recommended to perform ultrasound-guided arteriovenous dialysis access flow-limiting surgery to reduce the blood flow in the fistula.

August 8, 2025
Industrial VOCs Removal Additive: A Key Solution for Cleaner Production

Volatile Organic Compounds (VOCs) are a major group of pollutants in industrial emissions. They are released from various industrial processes such as painting, printing, chemical manufacturing, and more. VOCs not only contribute to the formation of smog and ozone in the atmosphere but also pose significant risks to human health, causing respiratory problems, headaches, and in severe cases, even cancer. As environmental regulations become increasingly stringent worldwide, industries are under great pressure to reduce their VOCs emissions. This is where Industrial VOCs Removal Additives come into play.
These additives are specifically designed to mitigate the release of VOCs. They work through several mechanisms. Some additives act as adsorbents, like certain zeolite – based materials. Zeo Flair series, for example, has a three – dimensional open structure. Zeo Flair 100/110 is a highly active, hydrophobic adsorbent that can effectively and permanently adsorb a wide range of hydrocarbons, solvents, and other toxic and non – toxic substances down to ppm levels, even in the presence of water. It strongly selects and adsorbs a wide range of VOCs/odors from the air based on organic compositions.
In the automotive industry, VOCs emitted from interior materials such as plastics, carpets, and adhesives are a concern. Aq Fresh, a new additive technology, has been incorporated into nonwovens, coated textiles, and plastics in automotive interior parts. It contains cucurbiturils, barrel – shaped molecules that can tightly bind a wide spectrum of unwanted VOC molecules, significantly reducing VOC and odor emissions.
Industrial VOCs Removal Additives also find applications in the pharmaceutical industry. 1 – ethyl – 3 – methylimidazolium acetate ((emim)(ac)) has been used to absorb dichloromethane and ethanol, two common pharmaceutical VOCs. The results showed high removal ratios, demonstrating the effectiveness of this ionic – liquid – based additive.
The benefits of using these additives are numerous. They help industries comply with environmental regulations, avoiding potential fines and reputational damage. From an economic perspective, they can reduce the need for additional handling or “airing out” of products, such as in the case of packaged goods where VOC – related odors might otherwise lead to customer rejects and returns. For example, DES VOCANT, made from a naturally – occurring bentonite clay mineral, helps control and eliminate the accumulation of VOCs from products enclosed in packaging, reducing the need for container ventilation during shipping.
Moreover, these additives are often non – toxic and easy to handle, and can be disposed of with normal industrial waste in some cases. In the future, with the continuous development of technology, Industrial VOCs Removal Additives are expected to become even more efficient and cost – effective. New materials and formulations will be developed to target a wider range of VOCs and to work under more complex industrial conditions, contributing to a cleaner and more sustainable industrial environment.

August 8, 2025
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July 30, 2025
Deodorizers for PVC, TPE and TPU: Resolving Odor Issues Across Industries

Odors emitted by PVC, TPE, and TPU materials can be a significant concern in various industries, from automotive to consumer goods. These synthetic polymers often release volatile organic compounds (VOCs) and other unpleasant smells during production, processing, or use, affecting both product quality and user experience. Fortunately, specialized deodorizers have been developed to address this issue effectively.
Deodorizer for PVC/TPE/TPU work through multiple mechanisms. Adsorptive types, such as activated carbon or zeolites, trap odor molecules within their porous structures, preventing their release into the air. Chemical neutralizers, on the other hand, react with the volatile compounds, converting them into non-odorous substances. Some advanced formulations also include masking agents that release a pleasant fragrance to override remaining unwanted smells, though this is often used in conjunction with other methods for long-term results.
These deodorizing solutions are designed to integrate seamlessly into the manufacturing process. They can be added during compounding, extrusion, or molding without compromising the material’s mechanical properties, such as flexibility, durability, or heat resistance. This compatibility is crucial, as PVC, TPE, and TPU are valued for their diverse performance characteristics in applications ranging from gaskets and seals to footwear and medical devices.
When selecting a deodorizer, factors such as the specific polymer type, processing conditions, and target odor sources must be considered. For instance, PVC may emit odors from plasticizers, while TPEs might release compounds from their rubber components. Tailored deodorizer formulations ensure optimal efficacy, meeting industry standards for safety and environmental friendliness.
In conclusion, effective deodorizers play a vital role in enhancing the appeal and usability of PVC, TPE, and TPU products. By neutralizing or eliminating unwanted odors, they contribute to better consumer satisfaction and broader application possibilities for these versatile materials.

July 29, 2025
Plastic Deodorant: A Solution to Unwanted Odors in Plastic Products

Plastic products have become an indispensable part of our daily lives, from food containers and water bottles to toys and household appliances. However, one common issue that plagues many plastic items is the development of unpleasant odors over time. This is where plastic deodorant comes into play, offering an effective solution to eliminate or reduce these unwanted smells.

Plastic deodorant works through a combination of chemical and physical processes. Chemically, it contains active ingredients that neutralize the odor-causing molecules present in the plastic. These ingredients can react with the volatile compounds responsible for the bad smell, breaking them down into harmless substances. Physically, some plastic deodorants work by absorbing the odors, similar to how activated charcoal absorbs impurities. The porous structure of certain components in the deodorant allows them to trap the odor molecules, preventing them from being released into the air.

One of the key advantages of plastic deodorant is its versatility. It can be used on a wide range of plastic products, regardless of their type or size. Whether it’s a smelly plastic lunch box, a musty plastic storage bin, or a toy that has picked up odors over time, plastic deodorant can help restore freshness. Additionally, many plastic deodorants are designed to be long-lasting, providing continuous odor protection for an extended period.

When using plastic deodorant, it’s important to follow the instructions provided by the manufacturer. Typically, the deodorant can be applied directly to the surface of the plastic item, either by spraying, wiping, or placing a sachet containing the deodorant inside. For best results, it’s advisable to clean the plastic item thoroughly before applying the deodorant to ensure that any dirt or grime doesn’t interfere with its effectiveness.

In conclusion, plastic deodorant is a practical and efficient solution for dealing with odors in plastic products. It helps to keep our plastic items smelling fresh, enhancing their usability and prolonging their lifespan. As we continue to rely on plastic in our daily lives, plastic deodorant plays an important role in ensuring that these products remain pleasant to use.

July 22, 2025
Custom Deodorizer for Plastics: Enhancing Material Quality

Custom deodorizers for plastics are tailored solutions to eliminate or mask unpleasant odors in plastic products, a key need in industries from packaging to automotive. These formulations target volatile organic compounds (VOCs) and chemical byproducts that cause off-gassing, ensuring plastics meet strict olfactory standards.
Working through adsorption, neutralization, or encapsulation, they bind to odor-causing molecules. Adsorptive types use activated carbon or zeolites to trap VOCs. Neutralizers, like amines or oxidizers, chemically react with odors to form inert compounds. Encapsulants seal odors within microspheres, preventing release.
Formulated for specific plastics—PE, PP, PVC—they integrate seamlessly during extrusion or molding without altering mechanical properties. Compatibility with additives like colorants or flame retardants is ensured via customization.
Applications are extensive. In food packaging, they eliminate resin or additive smells, ensuring food stays untainted. For medical devices like plastic syringes and containers, they meet strict sterility and odor norms, crucial for patient safety. In car interiors, they reduce off-gassing from dashboards and seat fabrics, enhancing cabin comfort. Household appliances such as plastic washing machine parts and refrigerator liners benefit too, keeping homes free from unpleasant plastic odors. Even toy manufacturing relies on them, ensuring safe, odor-free playthings for children.
As consumer demand for odor-free plastics rises, custom deodorizers play a vital role in enhancing product appeal and safety.

July 16, 2025
Rubber Compounding Odor Control: Challenges and Solutions

Rubber compounding, a crucial process in the rubber industry, often generates unpleasant odors that pose significant challenges. These odors mainly stem from volatile organic compounds (VOCs) released during the mixing of raw materials, such as rubber polymers, accelerators, and fillers. The emitted odors not only affect the working environment but also limit the application of rubber products in areas sensitive to smell, like automotive interiors and consumer goods.
Controlling rubber compounding odors is essential for both environmental and health reasons. VOCs are harmful to human health, causing respiratory problems and other health issues. Moreover, strong odors can lead to customer dissatisfaction, potentially damaging a company’s reputation. Therefore, effective odor control strategies are vital for the sustainable development of the rubber industry.
Several methods have been developed to tackle this problem. Physical methods involve the use of adsorbents, such as activated carbon, which can capture odor – causing molecules. Chemical methods focus on modifying the formulation of rubber compounds. For example, replacing high – odor accelerators with low – odor alternatives can significantly reduce emissions. Another approach is to add odor – masking agents that neutralize the unpleasant smells through chemical reactions.
Biological methods are also emerging as a promising solution. Microorganisms can be used to break down odor – causing compounds, offering a more environmentally friendly alternative. Additionally, advanced processing techniques, like vacuum degassing during compounding, can remove volatile substances before the final product is formed.
In conclusion, rubber compounding odor control is a complex yet necessary task. By combining different control methods and continuously researching new technologies, the rubber industry can effectively reduce odors, improve working conditions, and enhance the quality of rubber products. As environmental and health regulations become stricter, further innovation in odor control technologies will be crucial for the future of the rubber industry.

July 9, 2025
The Science and Art of Long-Lasting Odor Elimination

In a world where a pleasant and fresh environment is highly valued, long – lasting odor elimination has become an essential pursuit. Unwanted odors can originate from various sources, such as kitchens, bathrooms, pets, and even industrial settings, and effectively combating them requires a combination of scientific understanding and practical solutions.
One of the key methods for long – lasting odor elimination is the use of activated carbon. This highly porous material has an enormous surface area, allowing it to adsorb a wide range of odor – causing molecules. Air purifiers equipped with activated carbon filters can continuously clean the air, removing unpleasant smells over an extended period. In households, activated carbon – based deodorizers are commonly placed in closets, refrigerators, and shoes to absorb odors effectively.
Another important approach is the application of enzymes. Enzymes are natural proteins that can break down organic matter, which is often the root cause of many persistent odors. For example, in pet – friendly households, enzyme – based cleaners are used to tackle urine and feces odors. These enzymes break down the uric acid and other organic compounds in the stains, eliminating the source of the smell rather than just masking it, thus providing long – lasting odor control.
Advancements in technology have also led to the development of new materials and products for odor elimination. Nano – technology, for instance, has enabled the creation of more efficient and long – lasting odor – absorbing substances. Some innovative coatings can be applied to surfaces, continuously neutralizing odors for months or even years.
In the future, long – lasting odor elimination is likely to see even more breakthroughs. With the increasing focus on environmental sustainability, there will be a greater emphasis on developing natural and eco – friendly odor – eliminating solutions. Additionally, the integration of smart technology may allow for real – time monitoring and automatic activation of odor – control systems, ensuring a consistently fresh environment. Long – lasting odor elimination is not just a convenience; it is a crucial aspect of maintaining a healthy and comfortable living and working space.

July 2, 2025
Seledora® Coronary Scoring Balloon Catheter– Product Overview

“Precise lesion preparation” and “vascular functional restoration” are the main themes in current coronary interventional therapy.

Compared with common balloon angioplasty, which compresses plaques in a disordered manner, scoring balloons offer a more targeted solution. On the one hand, the scoring elements focus pressure on the lesion, enabling controlled plaque modification and reducing the risk of irregular dissections that could restrict blood flow. On the other hand, for moderate to severe, especially circumferential calcified lesions that are often hard to cross with other devices, scoring balloons can embed their elements into the plaque and dilate it at low pressure. This approach helps to gradually open the lesion, creating favorable conditions for further lumen preparation and maintenance—— achieving true precise lesion preparation.

Seledora® Coronary Scoring Balloon Catheter

The Seledora® Coronary Scoring Balloon Catheter features a deliverability profile of 0.0165″, equivalent to a conventional pre-dilatation balloon. It is equipped with three triangular nylon scoring ridges, each 0.42 mm in height, evenly distributed at 120° intervals along the balloon’s proximal and distal ends. This design ensures excellent lumen gain while maintaining good crossability.

Ex Vivo Simulation Results
The Seledora® scoring balloon demonstrated uniform and consistent scoring morphology aligned with the direction of blood flow, indicating effective and controlled plaque modification.

Clinical Benefits

The immediate lumen gain in the test group showed no statistically significant difference from the control group, confirming the non-inferiority of the Seledora device. Safety and secondary efficacy outcomes were also comparable between the two groups.

Specifications Chart

By enabling low-pressure, focused dilatation and directional, controlled plaque scoring, the Seledora® Coronary Scoring Balloon Catheter facilitates effective lumen gain and precise lesion preparation. This paves the way for optimized lumen modification and maintenance, enhances the drug release performance of DES (drug-eluting stents) and DCB (drug-coated balloons), reduces restenosis, ensures long-term treatment efficacy, and ultimately benefits the patient.

July 2, 2025
Odor-Free Plastic Additive: Transforming the Plastic Industry

In the realm of plastic manufacturing, the emergence of odor-free plastic additives has brought about a revolutionary change. These additives are designed to eliminate or significantly reduce unpleasant odors that often plague plastic products, especially those made from recycled materials.
One of the primary functions of odor-free plastic additives is to neutralize the odorous compounds generated during the plastic processing. For instance, in recycled plastics, the pre-processing cleaning might not completely remove all impurities, leading to a foul smell. The additive acts as a neutralizer, inhibiting the production of these odor-causing chemicals. It does this by capturing light aromatic molecules that are produced, for example, due to the use of peroxides in the polymer manufacturing process. This is particularly effective against aldehyde molecules and carboxylic acids, which are common sources of unpleasant odors in plastics.
The applications of odor-free plastic additives span across multiple industries. In the toy industry, where plastic toys are in direct contact with children, these additives play a crucial role. Children often carry toys everywhere, and plastic toys are prone to environmental exposure, which can cause them to emit odors. By using odor-free additives, manufacturers can ensure the safety and durability of toys, safeguarding children’s health. The packaging industry also benefits greatly. Plastic bags and packaging that come in contact with food or are stored in various conditions can emit unpleasant odors, especially in humid environments. Adding odor-free additives helps maintain the consumer – friendly and environmentally – friendly properties of these packages. In the rubber products industry, items like new rubber mattresses, which are subjected to long – term travel and wrapped in layers, often emit strong odors. The production process of rubber products also generates odor – causing compounds such as \(H_2S\), \(CH_4\) gas, and mercaptan. Odor-free additives are commonly used here to counteract these odors.
There are several advantages to using odor-free plastic additives. Firstly, they enhance the quality of plastic products, making them more appealing to consumers. A product without an unpleasant smell is generally considered of higher quality. Secondly, they contribute to the competitiveness of plastic products in the market. In industries where the smell of the product can be a deal – breaker, such as the food packaging and toy industries, odor-free plastics have a clear edge. Thirdly, these additives help protect consumer health. By preventing exposure to unpleasant odors and potentially toxic substances that may be associated with the smell, they reduce the risk of long – term health problems related to inhaling such substances.
As the demand for high – quality, odor – free plastic products continues to grow, the development and use of odor-free plastic additives are expected to expand further. Manufacturers are constantly researching and innovating to develop more effective and environmentally friendly additives, ensuring a more pleasant and safe plastic – using experience for consumers worldwide.

June 25, 2025