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Endovascular Creation of an Arteriovenous Fistula (endoAVF) for Hemodialysis Access: First Results

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Abstract

Introduction

Surgical creation of a radiocephalic fistula is the gold standard of vascular access for hemodialysis. Recently, an endovascular approach for upper arm fistula creation (endoAVF) has been developed, which may be an alternative to open surgery. We describe a case series of eight cases showing feasibility, early complications and outcome of this novel treatment option.

Materials and Methods

Between July 2015 and February 2016, we created an endoAVF in eight patients. Indications for endoAVF were confirmed by a multidisciplinary vascular board upon the exclusion for Cimino fistula candidates. Patients were suitable for the procedure after a pre-therapeutic ultrasound showed adequate brachial and ulnar vessels and no ipsilateral central venous stenosis. Patient characteristics, technical success, total patient radiation dose, complication rates, time to maturation of endoAVF and clinical effectiveness at six months were assessed retrospectively.

Results

Creation of endoAVF using the everlinQ endoAVF system (TVA Medical Inc., Austin, TX, USA) was successful in all eight cases. There were one minor intraprocedural complication and no postoperative complications. Median time to endoAVF maturation was 63 days (range 26–137 days). One patient was lost to follow-up after the first monitoring visit. In the remaining seven patients, hemodialysis was started without problems. Patency after 6 months was 100%.

Discussion

The endoAVF demonstrated to be feasible and safe for the creation of arteriovenous fistula suitable for hemodialysis access. Further studies with more patients and longer follow-up periods are needed to assess long-term outcomes and comparability to surgical dialysis access creation.

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Abbreviations

AVF:

Arteriovenous fistula

endoAVF:

Endovascular arteriovenous fistula

RF:

Radiofrequency

ESRD:

End-stage renal disease

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Acknowledgements

N. Weiss and R.-T. Hoffmann received a research grant from TVA Medicals.

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Authors and Affiliations

  1. Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany

    Christoph Georg Radosa, Thomas Hofmockel, Verena Plodeck, Michael Laniado & Ralf-Thorsten Hoffmann

  2. Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany

    Julia Caroline Radosa

  3. Department of Internal Medicine III – Section Angiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany

    Norbert Weiss, Christine Schmidt & Sebastian Werth

  4. Department of Visceral, Thoracic and Vascular Surgery, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany

    Christian Gatzweiler

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  1. Christoph Georg Radosa
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  10. Ralf-Thorsten Hoffmann
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Correspondence to Ralf-Thorsten Hoffmann.

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Radosa, C.G., Radosa, J.C., Weiss, N. et al. Endovascular Creation of an Arteriovenous Fistula (endoAVF) for Hemodialysis Access: First Results. Cardiovasc Intervent Radiol 40, 1545–1551 (2017). https://doi.org/10.1007/s00270-017-1750-x

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