Simplified Technique for Percutaneous Transrenal Arteriovenous Dialysis Graft Creation in a Swine Model

Abstract

To investigate the experimental creation of a percutaneous arteriovenous graft via the renal vessels using a simplified technique and to report on its safety, complications, and 1-month follow-up. Transrenal arteriovenous grafts were created from the renal artery to the renal vein in six swine. Using a combined transfemoral and percutaneous approach, a 7 mm x 150 mm stent graft was deployed to create a renal vein limb, and a 6 mm x 150 mm stent graft was deployed to form the renal artery limb. The external portion of the arterial limb was telescoped into the venous limb to form one continuous loop and was placed into a subcutaneous pocket. The duration and technical success of the procedure were recorded. Shunt patency was assessed by auscultation and angiography, as well as by necropsy and histopathology. Arteriovenous graft creation was technically successful in all six animals with rapid arteriovenous shunting documented with angiography at completion. The mean procedure duration was 84 minutes (range, 70-130 minutes). Auscultation and angiography revealed that four of the six shunts were occluded at 4 weeks. Moderate (50% to 75%) diffuse in-stent angiographic stenosis was present in the two remaining animals. No technical complications occurred. Midterm complications of localized and gradual concentric stenosis due to mural thrombosis occurred in three animals. Graft infection resulting in late abrupt thrombosis occurred in four animals. Transrenal arteriovenous graft creation using the simplified technique can be performed safely in swine. Delayed complications including graft infection and in-stent stenosis must be addressed prior to use of the technique in clinical settings.