Related Experiment Video
Updated: Jan 18, 2026
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
The impact of minimally invasive dialysis access
Ngoh C Liew1, Sarah Chew2, Pei Ho3
1University Putra Malaysia, Serdang, Selangor, Malaysia.
Objective:
Minimal Invasive Dialysis Access (MIDA) for renal dialysis encompasses percutaneous arteriovenous fistula (pAVF) creation and the modified percutaneous Seldinger peritoneal dialysis catheter insertions (pPD). This review examines the impact of MIDA on technical success, maturation rates, patency, clinical benefits, complications, and cost.
Methods:
A review was made of the literature on MIDA including pAVF creation and pPD insertion regarding technical success rates, maturation rates, patency, clinical benefits, complications, and cost. Additional benefits of pAVF such as expansion of cannulation area and reduction of steal syndrome, and associated administrative challenges was assessed.
Results:
Percutaneous AVF can be performed outside the operating room by interventionalists and physicians of several specialties. Initial reports claim safe and efficacious use and equivalent patency to open surgery (sAVF). Percutaneous AVF with multiple venous outflows has the benefit of expanding the area for cannulation. The incidence of wound infection and steal syndrome is reduced. Most studies have been retrospective and there are no prospective randomized controlled trials. The cost-effectiveness of pAVF versus sAVF has been challenged. The recently modified pPD has reduced incidence of catheter misplacement with improved catheter survival. With equivalent efficacy and complication rates reported in prospective studies and without the need for surgery and general anesthesia, pPD should be cost-effective in skilled centers.
Conclusions:
MIDA is an innovative approach to dialysis access that offers benefits over open surgery. MIDA advantages include widened indications to the very sick patients, being performed under ultrasound and fluoroscopic guidance with local anesthesia. New devices are being developed that may meet stricter criteria with improved efficacy. The cost of device and added procedures required for maturation and patency may prevent widespread application for now. Real-world data is needed to determine long term clinical outcomes and cost-effectiveness. Additional skills training and team collaborations are likely key factors for success.
Insights
Minimal Invasive Dialysis Access (MIDA) offers a less invasive alternative for creating arteriovenous fistulas (pAVF) and peritoneal dialysis catheters (pPD). While MIDA shows promise for improved patient outcomes and reduced complications, further research is needed to confirm long-term cost-effectiveness.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Renal dialysis requires reliable vascular access, traditionally achieved through open surgical procedures.
- Minimal Invasive Dialysis Access (MIDA) represents an evolving approach, encompassing percutaneous arteriovenous fistula (pAVF) creation and modified percutaneous peritoneal dialysis catheter (pPD) insertions.
- Assessing MIDA's impact on technical success, maturation, patency, clinical benefits, and cost is crucial for optimizing dialysis strategies.
Purpose of the Study:
- To review the literature on MIDA, specifically pAVF and pPD procedures.
- To evaluate the technical success, maturation rates, patency, clinical benefits, and complication profiles of MIDA.
- To analyze the cost-effectiveness of MIDA compared to traditional open surgical methods.
Main Methods:
- Comprehensive literature review of studies on MIDA, including pAVF and pPD.
- Analysis of reported technical success, maturation, and patency rates.
- Assessment of clinical benefits, complications, and cost-effectiveness data.
Main Results:
- Percutaneous AVF (pAVF) can be performed effectively outside the operating room, with initial reports suggesting comparable patency to open surgery (sAVF).
- pAVF offers benefits like expanded cannulation areas and reduced steal syndrome, though cost-effectiveness remains debated.
- Modified percutaneous peritoneal dialysis (pPD) shows reduced catheter misplacement and improved survival, potentially being cost-effective in skilled centers due to equivalent efficacy and fewer procedural requirements than surgery.
Conclusions:
- MIDA presents an innovative, less invasive option for dialysis access, suitable for sicker patients and performed under local anesthesia with imaging guidance.
- Emerging devices and techniques may enhance MIDA efficacy, but device costs and additional procedures for maturation may currently limit widespread adoption.
- Long-term clinical outcomes and cost-effectiveness require further investigation through real-world data, with skills training and collaboration being key to successful implementation.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:15Dialysis
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications