Endovascular arteriovenous fistula creation

Last revised by Yuranga Weerakkody on 5 Jun 2021

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

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 1,2,3.

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 1. Specific consideration for endovascular arteriovenous fistulae creation is the presence and caliber of the perforator vein near the antecubital fossa 1,2,3.

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 1,2,3.

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 1,2,3.

Due to the reduction in surgical trauma (a risk factor for neointimal hyperplasia), endovascular techniques may reduce the need for subsequent re-intervention 1,2,3.

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 1,3.

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