Endovascular Arteriovenous Fistula Creation: A Review

Tyagi, Ravi; Ahmed, Syed; Navuluri, Rakesh; Ahmed, Osman

doi:10.1055/s-0041-1736531

Cited by 6 publications

(8 citation statements)

References 14 publications

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“…La vena perforante comunica el sistema venoso superficial y profundo y, en la mayoría de los casos, se ubica en la zona distal del codo. La presencia y características de esta vena son importantes para la creación de una FAV percutánea, ya que es la que permite que la sangre venosa arterializada del sistema venoso profundo llegue al sistema venoso superficial y la FAV pueda utilizarse 11 .…”

Section: Valoración Preoperatoriaunclassified

“…La profilaxis antibiótica se alinea con los protocolos hospitalarios de cada centro 7 . En cuanto a la anestesia, es posible realizar un bloqueo regional axilar o supraclavicular para favorecer la dilatación venosa 7 , aunque la anestesia local junto con sedación también es una opción viable 11 .…”

Section: Procedimiento Quirúrgicounclassified

“…Tras la punción, una guía de calibre 0.014 se dirige en dirección distal hacia la vena y la arteria cubital, o hacia la vena y la arteria radial. El catéter venoso dispone de un electrodo que se coloca frente a un respaldo de cerámica en el catéter arterial y emplea energía de radiofrecuencia durante un lapso de 0.7 segundos para la creación del acceso 9,11 . Algunos grupos 9,17 prefieren la anastomosis cubito-cubital debido a la proximidad de la vena cubital con la vena perforante.…”

Section: Sistema Wavelinq™unclassified

“…Cada catéter dispone de indicadores de rotación que garantizan la posición de los imanes 18 . Una vez finalizada la anastomosis, se verifica el flujo de la FAV mediante una fluoroscopia con contraste 11 (Figs. 4 y 5).…”

Section: Sistema Wavelinq™unclassified

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Fístulas arteriovenosas endovasculares para hemodiálisis: una opción terapéutica. Revisión de la bibliografía

Mondragón-Zamora,

Requejo-García,

Salazar-Álvarez

et al. 2024

RMA

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Un acceso vascular funcionante es fundamental para los pacientes en hemodiálisis, pero mantener este permeable, es un reto. Existen varias técnicas para conseguirlo, las más utilizadas son la colocación de un catéter venoso central y la creación de una fístula arteriovenosa. Actualmente se trabaja para desarrollar técnicas menos invasivas, como la creación de accesos percutáneos, entre los que se incluyen los dispositivos Ellipsys TM y WavelinQ TM . El objetivo de este trabajo es revisar la bibliografía de estos dispositivos, las instrucciones de uso y sus resultados. La permeabilidad primaria es del 51.85% y del 47.97% para WavelinQ TM y Ellipsys TM , respectivamente. La permeabilidad secundaria fue del 81.36% y 92.12%, respectivamente. El éxito técnico es cercano al 100%. Las fistulas arteriovenosas percutáneas se presentan como una opción mínimamente invasiva y segura para la creación de accesos vasculares destinados a la hemodiálisis.

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Section: Valoración Preoperatoriaunclassified

Section: Procedimiento Quirúrgicounclassified

Section: Sistema Wavelinq™unclassified

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Fístulas arteriovenosas endovasculares para hemodiálisis: una opción terapéutica. Revisión de la bibliografía

Mondragón-Zamora,

Requejo-García,

Salazar-Álvarez

et al. 2024

RMA

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“…Health care providers create AVFs either through open surgical or minimally invasive endovascular or percutaneous procedures (i.e., endovascular AVF creation [EndoAVF]). 13,14 Open surgical procedures involve a vascular surgeon creating an incision in an upper extremity to create an AVF, typically using nonabsorbable sutures� 13,14 EndoAVF, a newer approach, involves a health care provider accessing blood vessels through punctures in the skin and guiding an endovascular device to a site where it can be used to create an AVF, either through radiofrequency or thermal energy� 13 Whether performed surgically or endovascularly, procedures to create AVFs ideally should take place 3 to 6 months before a patient needs hemodialysis to allow time for any necessary surgical revision and for the site to mature so it can be accessed using a needle for hemodialysis� 5,13 However, as detailed by Brown et al�, 15 patients may experience barriers to accessing or benefiting from these procedures. Of note, the authors reported that certain equity-deserving groups, such as older adults, females, and people who are Black, living in rural and remote communities, or without health insurance may experience disproportionately lower rates of timely access to AVFs and successful AVF maturation� 15 Traditional open surgical AVF creation procedures require operating room time� However, resource constraints may result in extended surgical wait times, limiting the number of patients who can initiate hemodialysis with AVF� When unable to receive timely access to a functional AVF, patients may receive a CVL, which, as detailed earlier, may be associated with higher rates of risks such as infections� 6,7 The novel, minimally invasive EndoAVF procedure may reduce costs and wait times associated with surgery� EndoAVF may also be safe, although evidence regarding its clinical efficacy may be limited in quantity and quality.…”

Section: Context and Policy Issuesmentioning

confidence: 99%

Perspectives and Experiences Regarding the Creation of Arteriovenous Fistulas for Hemodialysis Access: A Rapid Qualitative Review

Bentz,

Bailey

2023

cjht

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This review focused on the perspectives and experiences of adults with end-stage renal disease (referred to as “patients”), their families, and their health care providers regarding accessing, offering, deciding about, undergoing, performing, and recovering from procedures to create arteriovenous fistulas (AVFs) for hemodialysis. AVFs are connections between an artery and vein used for vascular access, a process that allows a hemodialysis machine to access a patient’s blood. A total of 8 qualitative studies were synthesized. Patients and health care providers mostly valued shared decision-making (SDM) when deciding to undergo procedures to create AVFs. The perceived benefits of SDM include patients’ increased knowledge of their condition, satisfaction, greater sense of control, and improved coping abilities. Yet, some health care providers continue to practice traditional prescriptive approaches to decision-making. Contextual factors influenced decision-making approaches and patients’ agency to access or refuse procedures to create AVFs. These factors included values, beliefs, and attitudes; the timing of decision-making; and human, structural, financial, and informational resources. People who are racialized and those experiencing poverty, houselessness, or language barriers may disproportionately experience difficulties engaging in timely and informed SDM; as a result, they may make uninformed decisions or experience traumatic unplanned dialysis initiation using a form of vascular access they did not choose. Decision-makers may consider promoting SDM practices by integrating SDM criteria in health care performance measures and SDM reimbursement models. They may also consider providing decision aids and SDM coaching to health care providers. They may also consider tailored interventions based on unique social, financial, and language-related needs to promote equitable access to procedures to create AVFs. During decision-making, patients weigh factors such as trust in their health care providers, past experiences, the invasive nature of procedures to create AVFs, and the anticipated outcomes of these procedures. Patients’ fears of being “cut” or experiencing pain and complications could hinder their engagement in these procedures. Patients’ concerns about an AVF being dysfunctional or hard to maintain and the anticipated pain of needles could also prevent them from wanting AVFs. Additional concerns included the risk of bleeding and an AVF’s impact on physical appearance. The included literature provided limited insights into the perspectives and experiences of undergoing, performing, and recovering from procedures to create AVFs. However, some patients and their families experienced financial and emotional burdens while accessing these procedures in Canada. This can be exacerbated by prolonged surgical wait times and rescheduling. People in rural communities, who often had to travel long distances for care, experienced these burdens more than those living in urban areas. Additionally, 1 study reported that surgeons often lead decision-making regarding anesthesia for surgical AVF creation procedures. While considering patient preferences, some health care providers perceive that regional anesthesia made these surgeries easier to perform, potentially resulting in better-quality AVFs. However, barriers to implementing regional anesthesia include limited human resources, funding, and time. Finally, patients recovering from procedures to create AVFs reported experiencing pain and fear related to the possibility of never using their AVF. None of the included studies explicitly reported experiences of endovascular procedures to create AVFs. Unlike surgical procedures, these more recent techniques can take place in office-based practices, are noninvasive, and may not cause surgical scarring. Research is needed to explore how implementing endovascular procedures to create AVFs would impact patients’ experiences, outcomes, and access to procedures to create AVFs. Further research is needed to explore health care provider and system barriers to using regional anesthesia.

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Multidisciplinary working group: key role for percutaneous endovascular AV fistula program. Point of view

Fanelli,

Falcone,

Gabbani

et al. 2023

J Nephrol

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Endovascular Arteriovenous Fistula Creation: A Review

Cited by 6 publications

References 14 publications

Fístulas arteriovenosas endovasculares para hemodiálisis: una opción terapéutica. Revisión de la bibliografía

Fístulas arteriovenosas endovasculares para hemodiálisis: una opción terapéutica. Revisión de la bibliografía

Perspectives and Experiences Regarding the Creation of Arteriovenous Fistulas for Hemodialysis Access: A Rapid Qualitative Review

Multidisciplinary working group: key role for percutaneous endovascular AV fistula program. Point of view

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