Early experience with endovascular arteriovenous fistula creation

Abstract

Background: Patients opting for haemodialysis as a form of renal replacement therapy require prompt and reliable vascular access. The gold standard for delivering high-quality and safe haemodialysis is through the creation of an arteriovenous fistula (AVF), typically formed at the wrist or elbow. This intervention promotes increased blood flow through superficial veins, fortifying them for repeated needle insertion during haemodialysis treatment. The emergence of percutaneous endovascular arteriovenous fistula (pAVF) introduces a non-surgical alternative for AVF creation. This method eliminates the need for incisions, reducing the likelihood of surgical scarring and changes in vein appearance. Advantages of pAVF encompass the potential for accelerated convalescence, enhanced comfort for the patient, and a diminished adverse effect on body image perception. These non-surgical options may motivate patients to undergo the procedure promptly, enhancing the timeliness of vascular access for haemodialysis and positively impacting overall health outcomes. These relatively new interventions are evolving, enabling the refinement of more efficient and safer techniques. Dialysis nurses play a crucial role in overall success, necessitating further training and development of their skills and knowledge for needling these new fistulas. With an increasing number of successful cases and more readily available information, these non-surgical techniques are gaining popularity among patients, particularly those conscious about their body image. Aim: The goal is to outline an early experience with a comprehensive approach to planning a percutaneous endovascular arteriovenous fistula service at King's College Hospital. Method: This article describes the referral process, screening, clinical assessments, procedural elements and cannulation. Insights are drawn from a single-centre experience in the UK with the WavelinQ System (BD). Emphasis will be placed on key staffing needs, particularly related to patient selection and dialysis nurse training. Conclusion: By addressing these essential considerations, a pAVF service can be successfully implemented.