Abstract
Abstract Background and Aims Creation of native arteriovenous fistulae(AVF) has been traditionally through open surgical technique. Endovascular creation of AVF (EndoAVF) has been shown to be an effective alternative to open surgery in Europe and North America. In Asia, EndoAVF creation is a novel technique and we report our early experience of EndoAVF creation in a case series of 18 patients. Method Between Nov 2021 to Aug 2022, ultrasound vein mapping was performed in a total of 39 patients. Eighteen patients were deemed suitable for EndoAVF and proceed for the procedure. EndoAVF creation was attempted by multidisciplinary team comprising of vascular surgeon, interventional radiologists and nephrologists. The patients were prospectively followed-up for at least 6-months. Baseline demographics, vascular characteristics, unassisted maturation, functional patency and freedom from intervention were studied. Results Table 1 shows the baseline demographics of the participants. Twelve patients (67%) were already initiated on hemodialysis via tunneled dialysis catheters during the procedure. EndoAVF was successfully created in 16 (89%) patients. Of which, 13 (72%) were WavelinQ while the remaining 5 (28%) were Ellipsys EndoAVF. The reasons of failures were inability to cannulate artery (n = 1) and vein (n = 1). Minor complications occurred in 6 patients: extravasation in 5 cases and hematoma in 1 patient. The brachial artery flow rates at creation and 1-month post-creation were 558 ± 328 and 583 ± 215 mls/min, respectively. Two participants (11%) underwent interventions to facilitate maturation of the EndoAVF. The median time to maturation was 70 (IQR 49 – 106) days while the median time to first successful 2-needle cannulation was 77 (56 – 127) days. At 6-months, 8 (50%) of EndoAVFs that were successfully created required further intervention to maintain patency, while 1 EndoAVF was abandoned from failure to mature despite intervention Conclusion EndoAVF can be created successfully in a Southeast Asian population. Further studies with more patients and longer follow-up periods are needed to assess long-term outcomes.
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