Comparison of surgical versus percutaneously created arteriovenous hemodialysis fistulas

Ghazi Harika,Alexandros Mallios,Mahmoud Allouache,Alessandro Costanzo,Romain De Blic,Benoit Boura,William C Jennings

doi:10.1016/j.jvs.2020.12.086

Ghazi Harika, Alexandros Mallios + Show 5 more

Open Access

https://doi.org/10.1016/j.jvs.2020.12.086

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Abstract

ObjectiveThe aim of the present study was to compare the results between percutaneous arteriovenous fistulas (p-AVFs) created with the Ellipsys device (Ellipsys Vascular Access System; Avenu Medical, San Juan Capistrano, Calif) and surgical arteriovenous fistulas (s-AVFs). MethodsA single-center retrospective comparative study of the first 107 patients who had undergone p-AVF creation with the Ellipsys system from May 2017 to May 2018 with an equal number of consecutive patients who had undergone s-AVF creation in our center during the same period. The primary endpoints included the maturation and patency rates. The secondary endpoints were reintervention, risk of infection, and the incidence of steal syndrome and aneurysm formation. ResultsThe demographic, hypertension, and diabetes data were similar for both groups. The only difference between the two groups was that more p-AVF patients had already been receiving hemodialysis (61% vs 47%; P < .05). The p-AVFs showed superior maturation rates at 6 weeks (65% vs 50%; P = .01). The primary patency rates were greater for the s-AVFs at 12 months (86% vs 61%; P < .01). However, primary patency was comparable between the two groups at 24 months (52% vs 55%; P = .48). No significant difference was found in the secondary patency rates at 12 (90% vs 91%) and 24 (88% vs 91%) months. At the 2-year follow-up point, the rate of percutaneous reintervention was similar; however, the s-AVFs had required more frequent surgical revision (36% vs 17%; P = .01). Issues with wound healing and infection were also more frequent with s-AVFs (9% vs 0.9%; P < .01). ConclusionsFistulas created percutaneously with the Ellipsys system showed superior maturation rates and similar patency with s-AVFs created in an experienced high-volume vascular surgery practice. p-AVFs had a lower risk of wound healing issues, infection, and surgical revision. Larger, prospective, randomized multicenter studies are needed to confirm these findings.

Highlights

The only difference between the two groups was that more p-arteriovenous fistulas (AVFs) patients had already been receiving hemodialysis (61% vs 47%; P < .05)
The primary patency rates were greater for the surgical arteriovenous fistulas (s-AVFs) at 12 months (86% vs 61%; P < .01)
Fistulas created percutaneously with the Ellipsys system showed superior maturation rates and similar patency with s-AVFs created in an experienced high-volume vascular surgery practice. percutaneous AVFs (p-AVFs) had a lower risk of wound healing issues, infection, and surgical revision

Summary

Methods

We retrospectively identified all patients who had undergone p-AVF and s-AVF creation from May 2017 to May 2018. All the patients had undergone preoperative venous and arterial ultrasound mapping. In accordance with the guidelines, we aimed for the creation of an AVF in the most distant possible location on the nondominant arm of the patient. Since May 2017, another option has been a surgical or percutaneous PRA AVF according to surgeon preference and if the ultrasound evaluation has indicated that puncture is possible for p-AVF creation. In the absence of the possibility for a proximal radial or ulnar artery AVF, a bc-AVF or bb-AVF will be created, with brachiocephalic having priority because it does not require superficialization in nonobese patients

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Discussion

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