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Updated: Jan 1, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Early cannulation of percutaneously created arteriovenous hemodialysis fistulae
Alexandros Mallios1, Gerald A Beathard2, William C Jennings3
1Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
Insights
Early cannulation of percutaneous arteriovenous fistulas (AVF) is a viable option for dialysis patients, offering high patency rates and avoiding initial catheter use. This technique provides a safe alternative to traditional surgical AV fistulas.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Arteriovenous fistula (AVF) is the preferred vascular access for dialysis.
- Many patients initiate dialysis with catheters due to access placement barriers.
- Percutaneous AVF offers a potential solution to improve vascular access outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of early cannulation of percutaneous AVF.
- To assess the feasibility of using percutaneous AVF as an alternative to traditional surgical AVF.
Main Methods:
- Early cannulation (<14 days post-creation) was performed in 14 patients.
- Ultrasound was used for mapping potential cannulation sites.
- Plastic fistula cannulas were utilized for cannulation.
Main Results:
- Successful cannulation was achieved in 13 out of 14 cases.
- Primary patency rates at 3, 6, and 12 months were 76%, 76%, and 66%, respectively.
- Assisted primary patency and cumulative patency remained high, reaching 100% at 3 and 6 months.
Conclusions:
- Percutaneous AVF with early cannulation is a safe and effective option for dialysis vascular access.
- This technique can be considered a reasonable alternative to surgically created AVF for selected patients.
- Early cannulation of percutaneous AVF may reduce the need for initial catheter placement and associated complications.
Introduction:
The optimal vascular access for most dialysis patients is an arteriovenous fistula and the recognized appropriate process of care for the chronic kidney disease patient is to have the access in place ready for use when renal replacement therapy is required. Unfortunately, as a result of multiple barriers, most patients start dialysis with a catheter and many experience multiple interventions. The recent advent of the percutaneous arteriovenous fistula may offer at least a partial solution to these problems. The purpose of this study was to report of the results of early cannulation of the percutaneous arteriovenous fistula.
Materials And Methods:
Early cannulation, less than 14 days post creation, was performed in 14 cases in order to avoid an initial catheter or continued use of a problematic catheter for dialysis. Immediately post access creation, blood flow ranged from 491 to 1169 mL/min (mean = 790 mL/min). Ultrasound was used to map potential cannulation sites prior to use. Cannulation was performed using plastic fistula cannulas.
Results:
Early cannulation was successful in this cohort of cases except for one cannulation complication. Dialysis treatments were otherwise uncomplicated. Primary patency at 3, 6, and 12 months was 76%, 76%, and 66%, respectively. Assisted primary patency for the same intervals was 100%, 100%, and 91%, respectively. Cumulative patency was 100% at all three-time intervals.
Conclusion:
The results of this study suggest that the possibility of successful early cannulation with a percutaneous arteriovenous fistula can be considered as an additional factor in making this access a reasonable alternative for a surgically created arteriovenous fistula in appropriate patients.
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01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications