Creation of “Puncture-suitable” Segments in Nonmaturing Arteriovenous Fistula Using Bovine Pericardial Patch Plasty

Objective: After surgical creation, dialysis access arteriovenous fistulas (AVFs) typically undergo an adaptive maturation process. This integrates two processes – an outward remodeling and wall thickening, for easy repetitive cannulation and an increase in adequate blood flow needed to support dialysis. Unfortunately, between 20% and 60% of AVFs do not mature, creating a major obstacle to successful AVF creation. Although it is impossible to replicate the biological process of AVF maturation by a surgical or endovascular intervention, various strategies exist that can make a nonmaturing AVF suitable enough to accommodate two puncture points and provide flow volume enough to perform an adequate hemodialysis session. Methods: In our case series, 18 patients were intervened surgically, those with nondilating veins with adequate flow rates (>500 mL/s) with a paucity of superficial dilated venous segments. To overcome these limitations, we introduced the concept of a “puncture-suitable” segment (PSS) by performing patch plasty of the nonmatured venous segment using a bovine pericardial patch (BPP). Results: Our experience of PSS creation using BPPs in nonmaturing fistulas resulted in a 100% technical success rate of cannulation on the first attempt with a primary patency rate of 100% and 77.7% at 1 and 12 months. Conclusions: In our experience, creation of a “PSS” using a BPP has shown promising results. This can be considered a novel and valuable surgical intervention for the long-term availability and patency of nonmaturing dialysis access AVFs.