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. 2021 Oct 20;3(2):287-292.
doi: 10.34067/KID.0004242021. eCollection 2022 Feb 24.

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

Alian Al-Balas  1   2 , Rakesh Varma  2 , Kedar Sharbidre  2 , Hassan Al-Balas  3   4 , Ammar Almehmi  1   2 , Ahmed Kamel Abdel Aal  5 , Michelle L Robbin  2 , Michael Allon  1
Affiliations

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

Alian Al-Balas et al. Kidney360. .

Abstract

Background: The 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.

Methods: All 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.

Results: During 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.

Conclusions: Among 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.

Keywords: AVF; arteriovenous fistula; dialysis; dialysis access; endoAVF; feasibility studies; venous mapping.

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Conflict of interest statement

M. Allon reports consultancy agreements with CorMedix and scientific advisor or membership with the Kidney360 Editorial Board as Editor-in-Chief. M.L. Robbin reports research funding from Philips Medical and scientific advisor or membership with the Journal of Ultrasound in Medicine Editorial Board, the Radiology Editorial Board, and the Ultrasound Quarterly Editorial Board. R. Varma reports speakers bureau for Becton, Dickinson and Company. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Endovascular arteriovenous fistula (endoAVF) creation. (A) The precreation venogram shows a direct perforator (yellow arrow) arising from the lateral ulnar vein (white arrow) and draining into the cephalic vein (green arrow). (B) The precreation angiogram shows opacification of the radial (blue arrow), ulnar (red arrow), and interosseous (green arrow) arteries without stenosis. The lateral ulnar vein and ulnar artery were selected as target creation vessels. (C) Arterial and venous catheters were advanced to the desired position on the basis of precreation venogram/angiogram. Note that the arc of the electrode (green arrow) is congruent with the concave surface of the arterial backstop. (D) The fistulogram shows successful endoAVF creation (white arrow) and coil embolization of the brachial vein (blue arrow) to redirect the flow to the cephalic vein and support maturation of the cannulation area.
Figure 2.
Figure 2.
Ultrasound vascular mapping showing suitable mapping for endoAVF. (A) Ulnar artery (UA) and ulnar veins (UVs) 2-cm caudal to the brachial artery bifurcation are shown. The UA diameter is 0.48 cm. (B) Radial artery (RA) and radial veins (RVs) 2 cm caudal to the brachial artery bifurcation are shown. The RA diameter is 0.43 cm. RV diameters are 0.37/0.44 cm. (C) Deep perforator. The diameter is 0.24 cm between the cephalic vein and the UV. (Note that the "Dist" annotations on the images are inner diameters.)
Figure 3.
Figure 3.
Schematic presentation of patients (Pts) who underwent preoperative vascular mapping between March 2019 and March 2021. AVF, arteriovenous fistula.
See this image and copyright information in PMC

Comment in

References

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