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Kidney Week

Abstract: SU-OR29

Single-Center Real-World Experience with Endovascular Arteriovenous Fistulas

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Genena, Kareem, Baylor University Medical Center at Dallas, Dallas, Texas, United States
  • Szerlip, Harold M., Baylor University Medical Center at Dallas, Dallas, Texas, United States
  • Mawla, Neghae, Dallas Nephrology Associates Vacular Center - Plano, Plano, Texas, United States
Background

Endovascular arteriovenous fistulas (EndoAVFs) are created percutaneously via an anastomosis between the radial artery and the perforator vein (Ellipsys), or between the ulnar artery and vein or radial artery and vein (Wavelinq). Flow is directed via the perforator vein to the superficial veins.

Methods

We report partial outcomes for 69 technically successful endoAVF creations for patients on hemodialysis between 5/2019 and 4/2020 using 2 catheter-based devices.

Results

12/69 endoAVFs failed (17%), all before reaching physiologic usability (ok to use) except for 1 which failed due to failure to cannulate at the dialysis center. The most common reason for failure was thrombosis of the perforator vein.
In 49 endoAVFs that reached physiologic usability at time of data review, mean duration from creation to physiologic usability was 92 days and mean number of procedures between endoAVF creation and physiologic usability was 1. At time of data review, 9 endoAVFs were pending physiologic usability.
14/49 (29%) of endoAVFs that reached physiologic usability did so with 0 secondary procedures. Mean postoperative brachial artery flow in this subset was 718 ml/min (range 400-1100 ml/min). Mean flow at 4-6 weeks was 843 ml/min. 35/49 (71%) needed at least 1 procedure. Mean postoperative flow in this subset was 545 ml/min. Mean flow at 4-6 weeks was 721 ml/min.
In 44 endoAVFs that had been cannulated at time of data review, mean duration from physiologic usability to cannulation was 9 days. In 33 patients whose dialysis catheters had been removed at time of data review, mean duration from first cannulation to dialysis catheter removal was 57 days.

Conclusion

Successfully created endoAVFs have shorter maturation time than surgical AVFs and require less maturation procedures. Immediate postoperative brachial artery flow is an important predictor of endoAVF behavior/outcome. All endoAVFs that reached physiologic usability with 0 secondary procedures had a postoperative flow above 400 ml/min, and mean postoperative flow was higher than those that needed at least 1 procedure. Time from first cannulation to dialysis catheter removal represents a pragmatic measure for endoAVFs. Cannulation injuries sometimes obligate a period of endoAVF rest. Removal of the dialysis catheter not only indicates functional usability of the endoAVF but also proficiency of the dialysis units in cannulating them.