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This study was undertaken to delineate clinical outcomes after endovascular arteriovenous fistula (endoAVF) creation at a single institution. In this institutional review board–approved retrospective study, review of electronic medical records for consecutive patients referred for endoAVF creation between January 2019 and December 2022 was undertaken. The population consisted of 49 patients (57% men, 43% women; mean age 58 years) with end-stage renal disease (n=32, 65%) or chronic kidney disease (n=17, 35%). The electronic medical record was reviewed for patient demographics, endoAVF technical outcomes, hemodialysis treatment outcomes, endoAVF patency outcomes, and adverse events (AEs). Forty-one of 49 patients (84%) underwent technically successful endoAVF creation; 8 patients (16%) had endoAVF creation aborted for anatomic reasons. Technically successful endoAVFs were created between the ulnar artery and vein (n=34, 83%) or radial artery and vein (n=7, 17%) under general anesthesia (n=14, 34%) or intravenous moderate sedation (n=27, 66%) with a brachial plexus block (all cases); concurrent brachial vein embolization was performed in 27 (66%) patients. Twenty-two (54%) patients required assisted maturation procedures (mean, 2 procedures per patient). Thirty-five of 41 endoAVFs (85%) matured at mean 91 days post-creation. Mean cephalic venous volumetric flow rate was 483 cm/min at time of maturation. Thirty-six patients required hemodialysis initiation during the study period and 31 (86%) patients successfully initiated hemodialysis. 1-year primary patency was 85%. Principal AEs included arm swelling (n=7, 17%) and steal symptoms (n=2, 5%). Five patients (12%) required surgical endoAVF ligation due to poor maturation, persistent arm swelling, and/or ischemic monomelic neuropathy. EndoAVFs can be created with reasonable technical success, and most mature to use, some requiring assisted maturation procedures. EndoAVF primary patency is acceptable. Safety is high but surgical closure may be necessary to address extremity symptoms.
Lamberty et al. (Wed,) studied this question.