Devices and Techniques for Percutaneous Creation of Dialysis Arteriovenous Fistulas

Abstract

Dialysis treatment for chronic kidney disease was first developed by Dr. Willem Kolff in 1943, and its availability began to grow in 1962 after which it has become a mainstay treatment for patients with chronic kidney disease. It is estimated that, in 2021, 15% of adults in the United States (∼37 million people) have chronic kidney disease, of which 661,000 individuals have renal failure, and 468,000 individuals require dialysis. There have been several advancements in dialysis treatment since its advent, most notably the creation of arteriovenous fistulas (AVFs) for venous access in 1966. In recent years, the U.S. Food and Drug Administration approved two new devices for AVF creation using a percutaneous approach. These are the WavelinQ (Becton Dickinson, New Jersey) and the Ellipsys (Avenu Medical, California) endovascular AVF (endoAVF) devices that use radiofrequency and thermal technologies, respectively, to create the AVF. Since the introduction of these technologies, several studies have shown that they are safe and effective, with favorable durability and low rate of serious adverse events. In this article, we will discuss these two devices and the techniques used for percutaneous creation of dialysis AVF as an alternative to traditional open surgical techniques.

Percutaneous endovascular arteriovenous fistula: A systematic review and meta-analysis

“…Currently, the WavelinQ system and the Ellipsys system, are the two endovascular devices. For the WavelinQ system, a dual catheter plays an important role in creating an anastomosis between the deep artery and vein in the proximal forearm ( 7 ). Whilst the Ellipsys system, is a 6-Fr single-catheter access system that provides heat and pressure to anastomosis between the proximal radial artery and the penetrating vein ( 38 ).…”

“…In recent years, percutaneous endovascular techniques, WavelinQ (Becton Dickinson, New Jersey) and Ellipsys (Avenu Medical, California), have been used to create AVF with minimal invasiveness ( 7 ). The devices allowed more clinicians to perform AVF independently due to the simple operation, which potentially reduced the waiting time and allowed patients to avoid surgical procedures.…”