Comparison of Surgical Versus Percutaneously Created Arteriovenous Hemodialysis Fistulas

Abstract

The aim of this study is to compare the results between percutaneous arteriovenous fistulas (p-AVF) created with the Ellipsys device and surgical arteriovenous fistulas (s-AVF). A single-center retrospective comparative study of the first 107 patients that had a p-AVF creation with the Ellipsys system between May 2017 and May 2018 with an equal number of consecutive s-AVF patients that had an access created in our center during the same time period. Primary end points included maturation and patency rates. Secondary end points were reinterventions, risk of infection, steal syndrome, and aneurysm formation. Demographic characteristics, hypertension, and diabetes were similar for both groups. The only difference between groups was that more p-AVF patients were already receiving hemodialysis (61% vs 47%; P < .05). p-AVFs had superior maturation rates at 6 weeks (65% vs 50%; P = .01). Primary patency rates were higher for s-AVF 12 months (86% vs 61%; P < .01); however, primary patency was comparable between the two groups at 24 months (52% vs 55%; P = .48). There was no significant difference in secondary patency rates at 12 (90% vs 91%) or 24 months (88% vs 91). At 2 years of follow-up, the rate of percutaneous reinterventions was similar, but s-AVFs required more frequent surgical revisions (36% vs 17%; P = .01). Issues with wound healing and infections were more frequent for s-AVF (9% vs 0.9%; P < .01). Fistulas created percutaneously with Ellipsys have superior maturation rates and similar patency with s-AVFs created in an experienced high-volume vascular surgery practice. pAVFs had a lower risk for wound healing issues, infection and surgical revision. Larger, prospective randomized multicenter studies are needed in order to confirm these findings.