#5029 PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION: A DUBAI HOSPITAL EXPERIENCE

Abstract

Abstract Background and Aims Targeting to improve the quality of care for chronic kidney disease patients (CKD) a non -surgical creation of native arteriovenous fistulae (AVF) with potentially cosmetic advantages, was offered for CKD patients in Dubai. The procedure started in January 2021 and the follow up continued till January 2023. The goal of this report is to share the original first experience in Dubai for this technique using 4F WavelinQ EndoAVF System. Method Fourteen patients underwent sonographic vascular mapping for endovascular AVF creation using 4F WavelinQ EndoAVF System. Nine patients were deemed suitable for Endovascular AVF creation and underwent the procedure under regional anaesthesia. Concomitant ulnar artery and ulnar vein or the concomitant radial artery and radial vein was used for the procedure. Results In this case series, the patients have a mean age of 53 ± 17 years, majority of the cases were men (77.8%). All cases were hypertensives (100%) with 2 cases(22.2%) have biopsy proven Glomerulonephritis and 5 cases (55.5%) were diabetics. The technique succeeded (defined by blood flow from used artery to concomitant deep vein and through perforator vein to superficial vein) in all patients (100%). Maturation success (defined as estimated fistula flow rates exceeded 500 mL/min and access vessel diameter was more than 4 mm) with multiple venous outflows was achieved in 8 cases (88.1%). One case (11.1%) showed primary maturation failure. Five cases (55.5%) achieved successful cannulation with excellent blood flow and reliable arterial and venous pressure during dialysis. Time to maturation was 35 ± 17 days and time to successful cannulation averaged 63 ± 45 days. Among patients achieving maturation success, one patient requested AVF closure (using coil embolization) due to mild to moderate upper limb oedema that required reintervention, one case underwent pre-emptive kidney transplantation and did not require to use the AVF and one patient refused using the AVF. In our study 3 cases (33.3%) required reintervention to facilitate maturation. It worth mention that among the 3 cases underwent reintervention, one case requested closure of the fistula and one case refused to use the fistula and only one case of the successful cannulation group underwent single reintervention. Conclusion In our limited experience, AVF creation using Endovascular technique resulted in dependable haemodialysis access with reliable maturation time, achieving excellent patency in the successful cannulation group with high blood flow rate and accepted arterial and venous pressure during dialysis. It also showed that the procedure was safe with better cosmetic shape and no scars. However more studies with bigger sample size are needed for better evaluation of the technique and to confirm the endovascular AVF creation proper position in the guidelines for vascular access creation in haemodialysis.