Dheeraj K Rajan1, Adrian Ebner2, Sudhen B Desai3, Jesus M Rios4, William E Cohn5. 1. Division of Vascular and Interventional Radiology, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada. 2. Cardiovascular Services, Italian Hospital, Asuncion, Paraguay. 3. Vascular Access Centers, Texas Heart Institute, Baylor College of Medicine, 6770 Bertner Ave., MC 2-114, Houston, TX 77030. 4. Center for Technology and Innovation, Texas Heart Institute, Baylor College of Medicine, 6770 Bertner Ave., MC 2-114, Houston, TX 77030. 5. Division of Cardiovascular Surgery, Texas Heart Institute, Baylor College of Medicine, 6770 Bertner Ave., MC 2-114, Houston, TX 77030.. Electronic address: wcohn@texasheart.org.
Abstract
PURPOSE: Arteriovenous fistulae (AVFs) created by conventional surgical techniques are associated with suboptimal short- and long-term patency. This study investigated the feasibility of creating fistulae with a percutaneous system and evaluated the utility of percutaneous AVFs (pAVFs) in providing hemodialysis access. MATERIALS AND METHODS: From August 2012 to September 2013, a percutaneous system was used to attempt pAVF creation between the proximal ulnar artery and a closely associated ulnar vein in 33 patients. Technical success, adverse events, and time to pAVF maturity were recorded, as was clinical effectiveness at 6 months. RESULTS: A pAVF was successfully created in 32 of 33 patients (97%). Four patients died during the follow-up period from causes unrelated to the procedure; one patient was lost to follow-up. Of the remaining 27 patients, 24 were undergoing successful dialysis via their pAVF at 6 months. Two additional patients had usable access but did not initiate dialysis during the study. One spontaneous pAVF thrombosis occurred in a patient with preexisting central vein stenosis. Cumulative pAVF patency at 6 months was 96.2% (26 of 27; standard error, 3.8%). Mean time to pAVF maturation was 58 days (range, 37-168 d). There was one serious procedure-related adverse event and five minor procedure-related adverse events. CONCLUSIONS: Although larger studies are required to validate efficacy in a wide range of patients, this study demonstrates hemodialysis access successfully created with an endovascular catheter-based system. Patency of pAVFs and time to maturation were superior to published results of surgical techniques.
PURPOSE:Arteriovenous fistulae (AVFs) created by conventional surgical techniques are associated with suboptimal short- and long-term patency. This study investigated the feasibility of creating fistulae with a percutaneous system and evaluated the utility of percutaneous AVFs (pAVFs) in providing hemodialysis access. MATERIALS AND METHODS: From August 2012 to September 2013, a percutaneous system was used to attempt pAVF creation between the proximal ulnar artery and a closely associated ulnar vein in 33 patients. Technical success, adverse events, and time to pAVF maturity were recorded, as was clinical effectiveness at 6 months. RESULTS: A pAVF was successfully created in 32 of 33 patients (97%). Four patients died during the follow-up period from causes unrelated to the procedure; one patient was lost to follow-up. Of the remaining 27 patients, 24 were undergoing successful dialysis via their pAVF at 6 months. Two additional patients had usable access but did not initiate dialysis during the study. One spontaneous pAVF thrombosis occurred in a patient with preexisting central vein stenosis. Cumulative pAVF patency at 6 months was 96.2% (26 of 27; standard error, 3.8%). Mean time to pAVF maturation was 58 days (range, 37-168 d). There was one serious procedure-related adverse event and five minor procedure-related adverse events. CONCLUSIONS: Although larger studies are required to validate efficacy in a wide range of patients, this study demonstrates hemodialysis access successfully created with an endovascular catheter-based system. Patency of pAVFs and time to maturation were superior to published results of surgical techniques.
Authors: Faekah Gohar; Patrick Maschmeyer; Bechara Mfarrej; Mathieu Lemaire; Lucy R Wedderburn; Maria Grazia Roncarolo; Annet van Royen-Kerkhof Journal: Front Med (Lausanne) Date: 2019-02-26