Initial single-center experience with a new external support device for the creation of the forearm native arteriovenous fistula for hemodialysis

Abstract

Objective: To assess and compare the maturation rate of the native radiocephalic arteriovenous fistula (RC-AVF) created with and without a nitinol external support (VasQ™ Laminate Medical Technologies Ltd, Tel Aviv, Israel).

Methods: Data of all consecutive patients who underwent the creation of native RC-AVFs at our center between October 2018 and January 2020 was prospectively collected and retrospectively analyzed.Selected patients who had a suitable vein and a radial artery with triphasic flow at preoperative duplex ultrasound exam and were selected for the creation of a radiocephalic fistula were included. Exclusion criteria were: malignant tumors, acute renal failure, previous upper limb revascularization, and septic status. Patency and maturation, vein, and artery diameter and blood flow rate were assessed at the following intervals: post-operatively, 24 h post-operatively, 1 month, 3 months, and 6 months post-operatively.

Results: Forty-nine patients (31 males, mean age 65.7 years old) were included. Patients who received VasQ™ devices were 25 (VasQ group), the other 24 formed the control group. All patients underwent radio-cephalic AVF placement (21 on the wrist, 20 on the forearm, 8 on the proximal forearm). There were no perioperative complications and fatalities. At 1, 3, and 6 months, primary patency rates were 96 ± 4%, 96 ± 4%, 91 ± 6% (VasQ group) versus 87 ± 7%, 87 ± 7%, 80 ± 9% (control group, P 0.17), secondary patency rates were 96 ± 4%, 96 ± 4%, 91 ± 6% (VasQ group) versus 95 ± 4%, 90 ± 7%, 90 ± 7% (control group, P 0.79). A significantly larger vein diameter increase postoperatively (P 0.009) and a greater maturation rate (96% vs 74%, p 0.044) were found in the VasQ group compared to the control group.

Conclusions: The use of the VasQ™ device was associated with higher maturation rates and larger vein diameters postoperatively. The patency rates were slightly higher but not significantly. Further studies are needed to confirm these findings.

Keywords: Arteriovenous fistula; VasQ™ device; end-stage renal disease; hemodialysis; nitinol support.