Recent Innovations and Advances in Arteriovenous Fistula Creation: A Narrative Review

Area of Science:

• Vascular Surgery
• Nephrology
• Biomedical Engineering

Background:

• Arteriovenous fistulae (AVF) are the preferred vascular access for hemodialysis.
• High primary failure rates and limited maturation/utilization necessitate ongoing innovation in AVF technology.

Purpose of the Study:

• To review novel approaches and emerging strategies aimed at improving AVF patency and function.
• To highlight the need for continued research into optimizing vascular access for hemodialysis patients.

Main Methods:

• Review of current and emerging technologies for AVF creation and maintenance.
• Discussion of strategies targeting neointimal hyperplasia, thrombosis, and sex-based differences in AVF maturation.
• Exploration of novel therapeutic approaches including drug-embedded wraps, immune modulation, and stem cell therapies.

Main Results:

• Current modifications (e.g., radial artery deviation, endovascular AVF) show limited success in preventing neointimal hyperplasia, stenosis, and thrombosis.
• Emerging strategies like drug-embedded wraps offer potential to prevent neointimal hyperplasia.
• Sex differences in AVF maturation and potential benefits of immune modulation and stem cell therapies are recognized.

Conclusions:

• Continued innovation is critical to overcome limitations in current AVF technologies and improve patient outcomes.
• Addressing neointimal hyperplasia, thrombosis, and sex-specific biology is key to enhancing AVF maturation and long-term patency.
• Further research is essential to optimize vascular access, reduce complications, and improve hemodialysis efficacy.