Early cannulation of percutaneously created arteriovenous hemodialysis fistulae

Abstract

Introduction: The optimal vascular access for most dialysis patients is an arteriovenous fistula and the recognized appropriate process of care for the chronic kidney disease patient is to have the access in place ready for use when renal replacement therapy is required. Unfortunately, as a result of multiple barriers, most patients start dialysis with a catheter and many experience multiple interventions. The recent advent of the percutaneous arteriovenous fistula may offer at least a partial solution to these problems. The purpose of this study was to report of the results of early cannulation of the percutaneous arteriovenous fistula. Materials and Methods: Early cannulation, less than 14 days post creation, was performed in 14 cases in order to avoid an initial catheter or continued use of a problematic catheter for dialysis. Immediately post access creation, blood flow ranged from 491 to 1169 mL/min (mean = 790 mL/min). Ultrasound was used to map potential cannulation sites prior to use. Cannulation was performed using plastic fistula cannulas. Results: Early cannulation was successful in this cohort of cases except for one cannulation complication. Dialysis treatments were otherwise uncomplicated. Primary patency at 3, 6, and 12 months was 76%, 76%, and 66%, respectively. Assisted primary patency for the same intervals was 100%, 100%, and 91%, respectively. Cumulative patency was 100% at all three-time intervals. Conclusion: The results of this study suggest that the possibility of successful early cannulation with a percutaneous arteriovenous fistula can be considered as an additional factor in making this access a reasonable alternative for a surgically created arteriovenous fistula in appropriate patients.

Two-year cumulative patency of endovascular arteriovenous fistula

“…The level of access blood flow obtained immediately following access creation has made early cannulation of the enAVF possible. In a study of 14 cases in which early cannulation was necessitated in order to either avoid catheter insertion or catheter exchange, 45 the time to first cannulation ranged from 1 to 12 days with a mean of 8 days. In six cases, time to first cannulation was 7 days or less.…”

Long-Term Results from the Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access

“…Data from the Ellipsys pivotal trial suggested better results with balloon angioplasty of the anastomosis and perforating vein immediately after fistula creation to treat spasm. Subsequent studies (11,12,(14)(15)(16) performing balloon angioplasty as part of the index procedure reported decreasing the early thrombosis rate from 12% to 3%, reducing the number of maturation procedures from 2 per patient to <1, and reducing the time to maturation using the original definition from the pivotal trial from a mean of 62 days to 11 days. The authors now consider the Kidney Health Initiative guideline of a target vein flow of ≥500 mL/min and diameter of ≥5 mm as a more appropriate proxy for physiologic fistula maturation (2).…”

Endovascular creation of hemodialysis arteriovenous fistulae: the current status and future perspective—a literature review

“…In a recent study, successful 2-needle cannulation was achieved at 10-day post-creation to avoid CVC placement (19). In addition, a recent study reported 14 patients were able to initiate early dialysis with a range of 1-12 days post-endoAVF creation, and a mean time-to-dialysis of 8 days (34). Although authors did not explore the difference between early and late cannulation cohorts, the results demonstrated that early cannulation may be feasible in selected patients.…”