Endovascular Arteriovenous Fistula Creation: A Single Center Experience

Endovascular systems represent an interesting technique for the non-surgical creation of an arteriovenous fistula (AVF) for hemodialysis. The aim was to evaluate the efficacy and the safety of the application of an endovascular system to perform AVF in ESKD patients treated at our center. Methods. Color Doppler ultrasound was used to assess anatomical criteria for patient's eligibility. Accurate clinical and instrumental post-procedural follow-up was carried out. Results. Endovascular AVF (endoAVF) was successfully created in 7 patients without peri-operative complications. During the procedure, coiling in the brachial vein (n = 4) and angioplasty were performed (n = 1) to divert more flow through the perforator to the superficial veins (cephalic, median cubital and/or basilic veins). Color Doppler ultrasound showed optimal 24-hour, 7-day, 30-day, 6-month and 12-month AVF flow rates. All endoAVF met maturation criteria within the first month and were successful cannulated. Primary patency rates at 4, 6 and 18 months were 100%, 85.7%, and 71.4%, respectively. Cumulative patency rate during follow-up (median 16 months) was 100%. During follow-up, 2 patients (29%) required corrective interventions with a re-intervention rate of 0.21 procedures per patient year. Conclusions. The study confirms this alternative technique for AVF creation as safe and effective. The implementation of a well-trained team including nephrologists and interventional radiologists is crucial to obtain and maintain a well-functioning endoAVF.