Feasibility of Creation of an Endovascular Arteriovenous Fistula in Patients Undergoing Preoperative Vascular Mapping

Abstract

BackgroundThe first endovascular arteriovenous fistula (endoAVF) device (WavelinQ), a novel percutaneous technique of AVF creation, was approved by the Food and Drug Administration in 2018 and has been placed in a small number of United States patients on hemodialysis. It is unknown how often patients with advanced CKD have vascular anatomy suitable for WavelinQ creation. The goal of this study was to determine the proportion of patients with vascular anatomy suitable for WavelinQ creation and to assess patient characteristics associated with such suitability.MethodsAll patients referred for vascular access placement at a large academic medical center underwent standardized preoperative sonographic vascular mapping to assess suitability for an AVF. During a 2-year period (March 2019 to March 2021), we assessed the suitability of the vessels for creation of WavelinQ. We then compared the demographic characteristics, comorbidities, and vascular mapping measurements between patients who were or were not suitable for WavelinQ.ResultsDuring the study period, 437 patients underwent vessel mapping. Of these, 51% of patients were eligible for a surgical AVF, and 32% were eligible for a WavelinQ AVF; 63% of those suitable for a surgical AVF were also suitable for a WavelinQ AVF. Patients with a vascular anatomy suitable for WavelinQ were younger (age 55±15 versus 60±14 years, P=0.01) but similar in sex, race, diabetes, hypertension, coronary artery disease, and peripheral artery disease.ConclusionsAmong patients with CKD with vascular anatomy suitable for a surgical AVF, 63% are also suitable for a WavelinQ endoAVF. Older patients are less frequently suitable for WavelinQ.

MRC avanzata e genere: una visione pluriprospettica /multidimensionale

“…3). Il limite di questa nuova metodica è rappresentato dai criteri di selezione del paziente estremamente restrittivi, come descritto in Letteratura (41).…”

Percutaneous Creation of Dialysis Arteriovenous Fistula: Patient Selection and Ultrasound Mapping

“…A study by Al-Balas found that younger age was more likely to be associated with favorable vascular anatomy for the placement of WavelinQ access, and comorbidities were not associated with favorable vascular anatomy. 13 Hence, the factors that need to be considered when creating a sAVF versus pAVF include patient preference, vascular anatomy, skin integrity, available provider expertise, and equipment. The technique for creation of pAVF has been described in other articles of this issue.…”

“…Patients with vascular anatomy suitable for pAVF were younger (age: 55 AE 15 vs. 60 AE 14 years, p ¼ 0.01), but similar to the sAVF group in sex, race, diabetes, hypertension, coronary artery disease, and peripheral artery disease. 13…”

Technological innovation in vascular access surgery: a reflection on two recent developments

“…The need for close proximity and adequate size of the target vein and artery and a suitable perforator vein are prerequisites for this procedure. In Al-Balas et al ’s single-centre prospective vascular mapping study, unsuitable anatomy meant only 32% of patients referred for vascular access were eligible for endoAVF 30. There are further weaknesses of the major trials evaluating the efficacy of endoAVFs to consider—the average age of patients involved in NEAT was 16 years younger than the average age of UK dialysis patients.…”