Abstract: TH-PO1284
Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation (pAVF) in a 1,000-Patient Cohort: Maturation, Patency, and Predictors of Abandonment
Session Information
- Late-Breaking Research Posters
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Sharaf, Rashid, Star Vascular, San Antonio, Texas, United States
- Reinhardt, Jemma, Dallas Nephrology Associates, Dallas, Texas, United States
- Cabrera, Timoteo, Star Vascular, San Antonio, Texas, United States
- Hull, Jeffrey E., Richmond Vascular Center LLC, North Chesterfield, Virginia, United States
Background
Hemodialysis vascular access remains the lifeline for patients with end-stage kidney disease (ESKD), and an autogenous arteriovenous fistula (AVF) is the access of first choice under all contemporary clinical guidelines. The development of ultrasound-guided percutaneous AVF (pAVF) creation has expanded the providers and locations of fistula creation. Adoption of pAVF as the primary method of arteriovenous fistula creation for a large nephrology group has not been described.
Methods
1,000 consecutive patients underwent ultrasound-guided pAVF creation by interventional nephrologists between October 2018 and July 2024 at an outpatient vascular center. Patients were followed through January 2025; the median follow-up duration was 234 days (range, 0–1,772 days). The Kaplan-Meier analysis was used to estimate maturation, primary patency, freedom from first complete thrombosis, cumulative patency (time to fistula abandonment), and time to central venous catheter (CVC)/permcath removal. Subgroup differences were tested with the log-rank test, and a multivariable Cox proportional-hazards model was fit for cumulative patency.
Results
Patient characteristics included mean age 62.4 ± 13.9 years; 62.2% male; 75.4% diabetic; 77.9% on dialysis at the time of pAVF creation). Successful pAVF creation was achieved in 97.1% (971/1,000) of patients. The Kaplan-Meier estimate of fistula maturation was 94.2% (95% CI 92.4–95.7) at 6 months and 97.2% (95% CI 95.8–98.2) at 1 year, with a median time to maturation of 61 days. Cumulative patency was 86.3% (95% CI 83.6–88.6) at 1 year, 83.2% at 2 years, and 77.3% at 3 years. Freedom from first complete thrombosis was 88.3% at 1 year and 85.1% at 2 years. The cumulative incidence of CVC/permcath removal was 67.3% by 1 year (median 168 days). In a multivariable Cox model for cumulative patency, female sex was the only baseline factor independently associated with fistula abandonment (HR for male sex 0.54, 95% CI 0.37–0.78, p = 0.0009); age, diabetes, hypertension, baseline dialysis status, obesity, target arm, and outflow vein were not significantly associated.
Conclusion
Ultrasound-guided pAVF creation produced high rates of maturation, durable mid-term patency, and effective transition to dialysis demonstrating the successful incorporation of pAVF on a large scale into a nephrology practice.
Funding
- Commercial Support – Ellipsys Medical Inc