Multi-Center Two-Year Patency Outcomes of Endovascular Arteriovenous Fistulas (endoAVF) Created with a 4 French System

Abstract

Purpose: To assess multicenter two-year patency outcomes of endovascular arteriovenous fistulas (endoAVF) created with the WavelinQ device.

Materials and methods: Patients who had fistulas created at three centers from January 2018 to December 2020 were included in this retrospective study. In total, 112 patients underwent endoAVF creation [40 females, 72 males; mean age 60 years (range 18-88)]. Data collected included patient demographics, location of fistula creation, interventions performed, and brachial artery flows pre- and post-creation. Two-year cumulative patency, functional patency, and primary patency were assessed with Kaplan-Meier methodology. Factors affecting patency and maturation were examined using the Cox proportional hazards model.

Results: Technical success defined as angiographically successful endoAVF creation was 97.3% (109/112). In 11 patients the fistula did not mature for dialysis use. For 98 patients (87%) with endoAVF maturation, 12- and 24-month cumulative patency was 94.3% and 91.7%. Functional patency (two-needle cannulation) at 12 and 24 months was 95.7% and 92.7%, respectively. Median maturation time is 95 days (IQR 51-231 days). Male gender and brachial vein coiling at the time of endoAVF creation were predictive of maturation. There were 34 censored events (four patients undergoing renal transplantation; 30 patients deceased). Number of reinterventions per patient year was 0.73 where 43 were maturation procedures and 101 were maintenance procedures. One Grade 3 complication occurred of arterial access puncture site pseudoaneurysm.

Conclusion: A high two-year functional and cumulative patency following endoAVF creation with the WavelinQ device was observed in this multicenter real-world experience Level of Evidence: 3 Level of Evidence III.

Keywords: Arteriovenous fistula; Endoavf; Hemodialysis; Percutaneous; Wavelinq.

Fig. 1

Radial artery to radial vein endoAVF. a Venogram of the lateral radial vein with opacification of the perforating vein (arrow) that fills the cephalic vein in the upper arm (CV) but also the brachial vein (BrV). b Venous catheter (VC) in lateral radial vein aligned with the arterial catheter (AC) in the radial artery (arrow showing alignment of footplate with endplate prior to endoAVF creation). c Post-endoAVF (arrow) creation with arteriogram performed from the radial artery demonstrating near equal venous filling of the cephalic (CV) and brachial veins (BrV) (CUA—common ulnar artery). d Post-coil embolization of the brachial vein (BrV). Arteriogram demonstrates preferential flow in the cephalic vein (CV) with greatly reduced flow in the brachial vein. e One month post-endoAVF creation, the fistula between the radial artery (RA) and radial vein (RV) is patent

Fig. 2

Cumulative patency

Fig. 3

Functional patency