Endovascular arteriovenous fistula creation

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Endovascular arteriovenous fistula creation is a recently developed minimally invasive alternative for the creation of arteriovenous fistulae for haemodialysis access.

Technique

Catheter-based technology and image guidance in the form of ultrasound and fluoroscopy is utilized create a side-to-side anastomosis between an artery and a vein by using a combination of heat, pressure and radiofrequency electrodes. There are currently a few devices available, and specific technique differs based upon the device used.  Current endovascular techniques create arteriovenous fistulae in the proximal forearm .

Fistulae may have multiple venous outflows resulting in a varying degree and distribution of venous outflow dilatation. Additional interventions can subsequently direct flow into a single venous outflow channel . Specific consideration for endovascular arteriovenous fistulae creation is the presence and caliber of the perforator vein near the antecubital fossa .

Outcomes

In contrast to surgical arteriovenous fistulae creation, endovascular techniques can be performed in a day case setting without the need for a surgical theater. Procedures are performed under local anesthesia and/or conscious sedation with the use of small incisions, theoretically allowing for quicker healing times. Further interventions may be required based upon the individual patient .

Evidence suggests that endovascular arteriovenous fistulae creation is a comparable alternative to surgical techniques and does not preclude surgical arteriovenous fistulae creation in the majority of patients. Endovascular approaches have been observed to have a high technical success rate and have demonstrated high rates of subsequent patency .

Due to the reduction in surgical trauma (a risk factor for neointimal hyperplasia), endovascular techniques may reduce the need for subsequent re-intervention .

Currently, further comparative studies and longer-term data are required to fully evaluate the utility of this emerging technique in the management of patients' requiring dialysis access .

Complications

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