Abstract: TH-PO760

Real-World Experience Utilizing Endovascular Arteriovenous Fistula (endoAVF) to Deliver Hemodialysis Treatment

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Dellanna, Frank, MVZ DaVita Rhein-Ruhr GmbH, Duesseldorf, Germany
  • Radosa, Christoph, Universitätsklinikum Carl Gustav Carus, Dresden, Dresden, Germany
  • Hoffmann, Ralf, Universitätsklinikum Carl Gustav Carus, Dresden, Dresden, Germany
  • Nuth, Linda, Schön Klinik Düsseldorf, Düsseldorf, Germany
  • Shahverdyan, Robert, Schön Klinik Düsseldorf, Düsseldorf, Germany
  • Steinke, Tobias, Schön Klinik Düsseldorf, Düsseldorf, Germany
Background

The arteriovenous fistula (AVF) is the primary option for end stage renal disease patients to receive hemodialysis treatment. However, the surgical trauma of dissecting, mobilizing and suturing the vein to the artery can lead to early AVF failure rates as high as 60% [1-4]. A novel endovascular approach to create AVFs has been developed to avoid this surgical trauma. This report describes the initial real-world experience with the endoAVF at two European vascular centers.

Methods

Consecutive dialysis and pre-dialysis patients who underwent the endoAVF procedure were followed to assess the ability to create a functional vascular access. Eligible patients were traditional surgical candidates for upper arm AVFs. Patients did not receive an endoAVF if they were ideally suited for a radiocephalic fistula (healthy arteries with a >2.5 mm forearm cephalic vein) or had a previously failed upper arm vascular access. Patients were followed to assess the technical success of the procedure, functional usability via two-needle cannulation, interventions necessary to mature and maintain the endoAVF and maturation time.

Results

An endoAVF was attempted in 23 patients between 07/2015 and 05/2017. The median age was 60 (25-84) with 65% male 61% pre-dialysis, 9% having a failed forearm fistula and typical comorbidities of the German dialysis patient population. Technical success was reported at 100%. Dialysis was successfully administered via 2-needle cannulation in 72% (13/18) of the patients; three patients were still pre-dialysis, one patient had less than 2 months follow-up and one was lost to follow-up. Three pre-planned vein elevations as well as three interventions to augment flow were performed. The median maturation time was 56 days (range: 10 – 86 days) at one center and 63 days (range: 26 – 137) at the other with the longest maturation times associated with elevation procedures.

Conclusion

The endoAVF procedure produced usable AVFs with high technical success. These real-world results are consistent with the results demonstrated in previous endoAVF clinical studies, FLEX [5] and NEAT [6].

1. J Vasc Surg 2012;55:274-80.
2. Kidney International, 2003;64:1487–1494
3. J Nephrol 2007;20:150-163.
4. JAMA 2008; 299:2164–2171
5. J Vasc Interv Radiol. 2015;26(4):484-490.
6. J Am Soc Nephrol 2016; 27:31A.