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Abstract: PO1042

Endovascular Arteriovenous Fistula Closure with Covered Stent Placement

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Patel, Ravi V., University of Wisconsin System, Madison, Wisconsin, United States
  • Pun, Conrad D., University of Wisconsin System, Madison, Wisconsin, United States
  • Chan, Micah R., University of Wisconsin System, Madison, Wisconsin, United States
  • Karim, Muhammad Sohaib, University of Wisconsin System, Madison, Wisconsin, United States
  • Gardezi, Ali I., University of Wisconsin System, Madison, Wisconsin, United States
Introduction

WaveLinQTM endovascular arteriovenous fistula (EndoAVF) system is a new technique that uses radiofrequency energy to create AVF. It has been gaining popularity as it avoids major surgery, has less recovery time and better success rates than surgical AVF creation. Pseudoaneurysm, dissection of brachial artery, intra-procedure brachial artery thrombosis, device embolization, and steal syndrome are described complications of the procedure. We present a case of EndoAVF creation complicated with forearm swelling and its successful management.

Case Description

Patient is a 45 y/o male with End-Stage Renal Disease due to Hypertensive Nephrosclerosis and obstructive uropathy, now s/p failed kidney transplant, currently on Peritoneal Dialysis (PD). PD was failing and decision was made to transition patient to hemodialysis (HD). In preparation of HD, AVF using WavelinQ EndoAVF system was placed in right forearm between intraosseous artery and vein with coiling of the medial brachial vein. A week after fistula creation, patient developed right forearm swelling with numbness and tingling. Fistulogram demonstrated stenosis in the perforator vein with poorly developed cephalic vein and diversion of blood flow to multiple superficial collateral veins in the forearm causing swelling. Multiple attempts at balloon assisted maturation of the cephalic outflow were unsuccessful. Due to persistent forearm swelling with discomfort a decision was made to close the fistula. A 5 x 15 mm self-expanding ViaBahnTM stent was deployed in interosseus vein across the anastomosis to close the fistula. Post fistula closure, arm swelling resolved completely.

Discussion

Covered stents have been used in the maintenance of hemodialysis AVF for various purposes including dialysis access stenosis, central vein stenosis, pseudoaneurysm exclusion and angioplasty associated vascular rupture that cannot be repaired using balloon catheter. This is the first reported case of successful use of covered stent graft to occlude anastomosis to close EndoAVF. As these fistulae are created more often, more novel complications will be encountered. It will be imperative for interventionalists to find creative solutions as well as actively report the successful management of complications.