Comparative outcomes of surgical versus percutaneous arteriovenous fistulas: a prospective study

For patients undergoing haemodialysis (HD), the choice of vascular access is pivotal in determining morbidity and mortality outcomes. Traditionally, native arteriovenous fistulas (AVFs) have been created through surgical procedures. However, percutaneous endovascular devices for AVF formation have been introduced into clinical practice, showing promising early results. This study aims to compare the outcomes of endovascular AVFs (endoAVFs) created using the WavelinQ EndoAVF System (BD, Franklin Lakes, NJ, USA) and surgically created radiocephalic (RC) AVFs in real-world settings.

This prospective, single-centre, two-arm study included patients who underwent the creation of either an endoAVF using the WavelinQ EndoAVF System or an RC AVF at a university hospital between December 2021 and August 2023.

A total of 20 patients who underwent an endoAVF and 40 who underwent a surgical AVF (SAVF) were included. Technical success was 100% in both groups. A total of 75% of the endoAVFs and 60% of the SAVFs met the criteria for physiological suitability. Among the AVFs that reached physiological suitability, the cannulation rate was 66% for the endoAVFs and 70.86% for the SAVFs. At the 6-month follow-up, the primary and cumulative patency rates were 65% and 75% in the endoAVF group and 57.5% and 60% in the SAVF group, respectively. At 12 months, these rates were 50% and 70% in the endoAVF group and 50% and 60% in the SAVF group, respectively. No serious adverse events were observed. The reintervention rate was 0.25/patient/year in the endoAVF group and 0.1 in the SAVF group.

The results of our study showed endoAVFs may be a safe and effective alternative to RC AVFs, showing high rates of technical success and patency with a low rate of reinterventions and complications.