Percutaneous Arteriovenous Fistula Research Articles

Homemade Device to Facilitate Percutaneous Venous Arterialization in Patients With No-Option Critical Limb Ischemia

Purpose: To describe a maneuver to facilitate percutaneous arteriovenous fistula creation during venous arterialization procedures in patients with no-option critical limb ischemia. Technique: Following a failed arterial recanalization attempt, a balloon catheter is passed up to the tip of the guidewire. Venous access is gained distally, a 4-F sheath is antegradely passed, and a 4-mm GooseNeck snare is advanced through it. A fluoroscopic view that overlaps the snare and the inflated balloon is obtained. If the vein remains anterior with respect to the artery, a needle is inserted across the vein, passing through the snare loop and puncturing the intra-arterial balloon. A wire is inserted and placed inside the punctured balloon. The balloon is retrieved and the wire externalized through the femoral access. A catheter is advanced antegradely over this wire from the artery into the vein. If the vein remains posterior to the artery, a needle is inserted, puncturing the balloon and thereafter the vein (crossing through the snare). A wire is inserted, captured by the snare, and externalized through the vein sheath. A catheter is finally advanced over this wire from the vein into the artery. Conclusion: This maneuver is a simple alternative to create an arteriovenous fistula during venous arterialization procedures in patients with no-option critical limb ischemia.

Early results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System

ObjectiveWe reviewed our initial experience creating a percutaneous arteriovenous fistula (pAVF) using a thermal resistance anastomosis device with proximal radial artery inflow. MethodsA retrospective review was conducted of all patients who underwent a pAVF creation procedure between May 2017 and October 2017. Primary end points of the study were technical success, patency by Doppler ultrasound examination or angiography, flow levels achieved, time to first use, and pAVF-related complications. ResultsA pAVF was attempted in 34 patients with technical success in 33 individuals (97%). Patency of the pAVF was 94%. Mean access flow was 946 mL/min (brachial artery measurement) at the latest follow-up visit (53-229 days; average, 141 days). At 6 weeks, all fistulas have been used or were ready for dialysis by clinical examination or ultrasound examination. Only one patient required superficialization of the upper arm cephalic vein by lipectomy. There were no adverse events related to the pAVF creation or use, nor was there need for further interventions. ConclusionsSuccessful pAVFs with proximal radial artery inflow were created with excellent initial results regarding technical success, patency, and safety. Advantages include avoidance of a surgical incision, short procedure times, good acceptance by patients, prompt access maturation, moderate flow, and low-pressure access, with possible reduction of risk for ischemic complications. Avoidance of vessel manipulation and side branch ligation might reduce risk of thrombosis and improve long-term patency and reduce need for further interventions. These early findings need to be confirmed in larger and longer follow-up studies.

Letter by Faul et al Regarding Article, “Percutaneous Femoral Arteriovenous Shunt Creation for Advanced Chronic Obstructive Pulmonary Disease: A Single-Center Safety and Efficacy Study”

To the Editor: We were interested to read the recent article by Bertog et al,1 published in your journal. Bertog et al report, for the first time, significant increases in cardiac output, mixed venous oxygen saturations, oxygen delivery, and functional capacity (significant reductions in New York Heart Association [NYHA] functional class) in patients with severe end-stage chronic obstructive pulmonary disease (COPD) with the use of the novel Rox procedure (percutaneous arteriovenous fistula creation). Their interpretation that “the creation of an arteriovenous shunt in the setting of severe chronic obstructive pulmonary disease did not improve functional capacity” is not convincing, because the data prove the opposite: an improved NYHA functional class, which is not only clinically significant (improved from class III to II) but also statistically significant ( P <0.01). Thus, the idea that an arteriovenous shunt (AVS) does not improve functional capacity is refuted by their data that demonstrate statistically significant improvements in NYHA functional class. Although Bertog et al did not demonstrate a significant change in 6-minute walking distance (6MWD) in …