Ulnar Artery Research Articles

Effectiveness of a microsurgery training program using a chicken wing model

Microsurgical skills are essential for plastic surgeons in the modern times. Chicken wing model for microsurgery training offers an easy and cost-effective alternative to the traditional live rat model. A prospective study was conducted over a period of 6 months. Fifteen resident doctors in the department of plastic surgery were enrolled. Each of them underwent one session of microsurgery training on chicken wings (ulnar artery) every week for 15 weeks. The pre-training and post-training microvascular anastomosis were recorded and analyzed by two blinded investigators using a modification of the Structured Assessment of Microsurgery Skills (SAMS) tool. The pre- and post-training scores were compared. Twelve residents completed the requisite number of training sessions and were included in the final analysis. The mean diameter of the chicken wing ulnar artery was 1.04 mm (SD:0.11). All trainees demonstrated an improvement in the total scores. There was significant improvement in the mean scores (Pre-training: 33.46 vs. post-training: 41.42, p = 0.002). There was also a significant decrease in the total number of errors (Pre-training: 6.75 vs. post-training: 4.79, p = 0.012). However, there was no significant improvement in the average time taken to perform anastomosis (Pre-training: 58.03 mins vs. post-training: 52.51 mins, p = 0.182). We concluded that chicken wing is a useful training model for microsurgery. It helps in improving the overall microsurgical skill as well as reducing the average number of errors. This model is cost-effective, easily available, and easy to set-up. The wide assortment of vessels with varying diameters provides opportunities for training of microsurgeons of different skill levels.

Systolic finger pressures during an Allen test before hemodialysis access construction predict severe postoperative hand ischemia

ObjectiveThe Allen test is a simple bedside method for determining hand perfusion. Earlier studies in patients on hemodialysis (HD) found that an Allen test before access construction did not predict hand ischemia later on. The study aimed to assess whether an Allen test combined with finger plethysmography before access surgery has a potential to predict the onset of severe HD access induced distal ischemia (HAIDI). MethodsBefore the first access construction in patients with chronic kidney disease, systolic finger pressures (Pdig, in millimeters of mercury) were obtained using plethysmography at rest and after serial compression of the radial and ulnar artery. A decrease in Pdig (∂Pdig) was calculated as the difference between Pdig-rest and Pdig-compression. The severity of postoperative HAIDI was graded as suggested by a 2016 consensus meeting. Patients with a severe type of HAIDI (grade 2b-4, intolerable pain, invasive treatment required) were compared with controls not having HAIDI. ResultsA total of 105 patients with chronic kidney disease (mean age 70 ± 13 years; 65% males) receiving their first access between January 2009 and December 2018 in one center fulfilled study criteria. Ten patients (10%) developed severe HAIDI at 14 ± 5 months after access construction. Before access creation, all patients with HAIDI demonstrated a radial or ulnar dominant hand perfusion pattern compared with just 57% in controls (P = .010). Compression resulted in an almost two-fold greater ∂Pdig in patients with severe HAIDI (51 ± 8 mm Hg vs 27 ± 3 mm Hg; P = .005). A 40-mm Hg ∂Pdig cut-off value demonstrated optimal tests characteristics (sensitivity of 80%, specificity of 77%, positive predictive value of 27%, negative predictive value of 97%) indicating a 10 times greater risk of developing severe HAIDI. ConclusionsFinger plethysmography quantifying ∂Pdig during an Allen test before access creation may identify patients who have a substantially increased risk of developing severe hand ischemia after HD access surgery.

Concomitant Acute Ischemic Stroke and Upper Extremity Arterial Occlusion: Feasibility of Mechanical Thrombectomy of the Upper Limb Using Neurointerventional Devices and Techniques.

Background: Concomitant acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and acute upper extremity arterial occlusion causing upper limb ischemia (ULI) is a rarely observed coincidence. The first-line treatment for AIS is mechanical thrombectomy (MT), with or without additional intravenous thrombolysis, while there are different pharmacological, surgical and endovascular treatment options for an acute occlusion of the UL arteries. Here, we describe the practicability, efficacy and safety of neurointerventional devices and techniques for MT of upper extremity arterial occlusions. Materials and Methods: A retrospective analysis of prospectively collected patient databases from four neurovascular centers was performed. Clinical and imaging data, as well as procedural parameters, were assessed. Results: Seven out of 6138 patients (incidence: 0.11%) presenting with an AIS due to the occlusion of craniocervical arteries requiring MT and a concomitant occlusion of the brachial (4/7), axillary (2/7), or ulnar (1/7) artery causing acute ULI were identified. Craniocervical MT was technically successful in all cases. Subsequent MT of the upper limb was performed using neurointerventional thrombectomy techniques, most frequently stent retriever thrombectomy (in 4/7 cases) and direct aspiration (in 7/7 cases). MT achieved successful recanalization in 6/7 cases, and the UL completely recovered in all six cases. In one case, recanalization was not successful, and the patient still had a marginally threatened extremity after the procedure, which improved after pharmacological therapy. Conclusion: In the rare case of AIS requiring MT and concomitant acute upper extremity arterial occlusion, MT of the UL arteries using neurointerventional devices and techniques is practical, effective, and safe.

Clinical effects of ulnar artery perforator chain flaps in repairing wounds on distal forearm or wrist with vascular anastomosis

Objective: To investigate the clinical effects of ulnar artery perforator chain flaps in repairing wounds on distal forearm or wrist with vascular anastomosis. Methods: The retrospective observational study method was used. From March 2015 to July 2019, a total of 11 serious trauma patients on distal forearm or wrist with vascular injury were admitted to the Second Hospital of Tangshan, including 8 male patients and 3 female patients, aged from 25 to 62 years, with an average age of 45 years. Vascular anastomosis and tendon repair were performed in all patients, and fracture reduction and fixation were conducted in 9 patients, of which 8 patients underwent external fixation of radius. The residual wounds were located in palmar distal forearm in 5 patients, palmar wrist in 4 patients, dorsal distal forearm in 1 patient, and dorsal wrist in 1 patient, with wound sizes ranged from 4.5 cm×3.0 cm to 10.0 cm×6.0 cm after the last debridement. The wounds were repaired with ulnar artery perforator chain flaps, with the flap sizes ranged from 5.2 cm×3.5 cm to 11.0 cm×7.0 cm. The wound in flap donor site of 1 patient was sutured directly, the wounds in flap donor sites of the other 10 patients were repaired with free skin grafts from ipsilateral thigh after being sutured partially, and the sizes of free skin grafts ranged from 4.0 cm×2.0 cm to 8.5 cm×5.0 cm. The survivals of flaps, skin grafts, and injured limbs after operation were observed. The appearances of the flaps and donor sites of flaps were observed during follow-up. At the final follow-up, the static two-point discrimination distances of the flaps were measured, and the satisfaction degrees of patients for the appearances of injured limbs were evaluated based on Michigan Hand Function Questionnaire. Results: All flaps, skin grafts, and injured limbs survived after operation, without wound infection and blister formation. All patients were followed up for 8 to 26 months, the appearances of the flaps were good and not bloated, with similar color, texture, and thickness to the surrounding skin. The donor sites of flaps repaired with skin grafts were smooth, with circle scar at the edges. At the final follow-up, the static two-point discrimination distances of the flaps was 10-15 mm; 7 patients were strongly satisfied with the appearances of the injured limbs, and the remaining 4 patients were satisfied with the appearances of flaps. Conclusions: The ulnar artery perforator chain flap has constant vascular anatomy and reliable blood supply, with simple operation, which provides a good treatment method for repairing wounds on distal forearm or wrist with vascular anastomosis. It is especially suitable for the patients with radius fracture fixed by external fixator.

Presentation of the hypothenar hammer syndrome as a low incidence aneurysmal disorder of the ulnar artery.

Introduction and importanceThe hypothenar hammer syndrome (HHS) is either rare or underdiagnosed condition that arises from vascular insufficiency of the ulnar artery in the hand. The most common accused mechanism is repetitive blunt trauma to hypothenar region while activating the latter as a hammer to do the job.Case presentationA 48 year old woman worked as a master of university claimed from pain and numbness in her left hand concurrent with a pulsatile mass. The second case was a 48 year old man who was a mechanic engineer in automotive industry that claimed of a pain and pulsatile mass in his non-dominant left hand.Clinical discussionUlnar artery enters the hand from Guyon's canal where fixes to adjacent structure and is susceptible for injury. Aneurysmal formation is an outcome of arterial trauma which could result in distal necrosis if remains untreated.ConclusionThis study has revealed that even whether a single blunt trauma or writing with pen could lead to aneurysmal formation. It has also showed primary aneurysmal resection with no further surgical procedure is both safe and reliable if digital ischemia is not concurrently present.

POST-OPERATIVE REHABILITATION IN TRAUMATIC DISTAL BICEPS TENDON RUPTURE WITH ULNAR ARTERY INJURY AND ULNAR NERVE NEUROPATHY MANAGED WITH SURGICAL RECONSTRUCTION

The Biceps Brachia is an anterior arm muscle consisting of two heads that bridge the shoulder girdle to the forearm. The distal biceps tendon from both heads may converge or remain anatomically separate before attachment to the radial tuberosity. The incidence of distal biceps rupture is 1.2/100,000 per year and is mostly seen in middle-aged men. The rupture of the biceps tendon is a relatively less common lesion making this case unique. Physiotherapy rehabilitation post-surgery is found to be effective; it includes management of pain, increase range of motion exercises, strengthening exercises, muscle energy technique, cardiovascular fitness, all these together helps to improve patient outcomes. A case of the 40-year-old female is presented in this case report who underwent traumatic glass-cut injury in proximal forearm resulting in distal bicep-tendon repair with ulnar artery injury and ulnar nerve neuropathy. After surgical reconstruction patient presented with pain in the shoulder, elbow, and wrist, reduced range of motion, strength, and grip strength leading to difficulty in performing activities of daily living. Surgical history, clinical findings, outcomes, and rehabilitation are mentioned in this report. We report that there is a significant improvement in stability, range of motion, muscle strength, relief from pain, and improvement in the patient's functional level and outcomes.

Outcomes of periarterial sympathectomy in patients with digital ischemia.

Digital ischemia with subsequent severe pain and tissue loss is often difficult to treat, with no obvious guidelines or strong evidence in the literature to support a specific treatment modality. Patients who fail medical treatment remain with very limited surgical options due to the difficulty of any intervention in this "no man's land" area of the hand, as described since 1918. Extended distal periarterial sympathectomy is reported as an effective treatment option since the eighties of last century. The procedure entails large incisions and major technical difficulties. In this study, we describe a less invasive approach with very promising results and equally high success rates. This was a prospective study. All patients with severe digital ischemia manifesting with bluish discoloration, ulceration, and/or dry gangrene who failed medical treatment underwent distal periarterial sympathectomy for the radial and ulnar arteries, with added digital sympathectomy in very severe cases. Primary endpoints were ulcer healing and improvement in pain scores assessed by Visual Analog Scale pain scoring system. Secondary endpoints included complications and amputation rates. This study recruited 17 patients between January 2019 and January 2020. The mean follow-up was 14.6months. The mean age was 33.71 (±SD 13.14)years. 41% were males. 59% suffered from vasculitis, 35% of patients had dry gangrene, and 71% had ulcers. Periarterial radial and ulnar sympathectomy was performed for all cases, with digital sympathectomy for 12 fingers. We had 50% complete ulcer healing within 1month (p = 0.031), and 100% were completely healed at 6months (p < 0.001). Pain scores showed significant reductions at 1 (p = 0.001) and 6 months (p < 0.001) of follow-up. Distal periarterial sympathectomy demonstrates high success rates in terms of pain relief and ulcer healing in severe digital ischemia.

A study of variations in formation of superficial palmar arch in Nepalese cadavers

Introduction: The superficial palmar arch (SPA) is the main source of arterial supply to the palm. It is an arterial arcade formed mainly by the ulnar artery and is completed by the superficial palmar branch of the radial artery. The study was conducted with objective to study the variations in formation of superficial palmar arch in Nepalese cadaveric hands.&#x0D; Methodology: Two horizontal incisions were made, one at the wrist joint and another incision along the root of fingers. A vertical incision was made from the middle of the wrist to the 3rd metacarpo-phalangeal joint. The skin of the palm and the palmar aponeurosis was reflected. The surrounding adipose tissue was removed to view the superficial palmar arch and its branches.&#x0D; Result: In present study, out of 50 specimens of hands, 64% of superficial palmar arch was formed as normal pattern and in 36% cases it was formed by ulnar artery alone. Normal SPA pattern was seen 63% in male and 66.7% in female i.e. higher percentage in female than in male but it was statistically insignificant (P&lt;0.05). SPA-ulnar artery alone pattern was seen 37% in male and 33.3% in female i.e. higher percentage in male than in female, however it was also statistically insignificant (P&lt;0.05).&#x0D; Conclusion: Normal pattern of SPA observed in Sixty-four percent of Nepalese hands and in thirty-six percent cases it was formed by ulnar artery alone. There was no statistically significant difference in SPA pattern distribution between Nepalese male and female.

Iatrogenic Ulnar Artery Pseudoaneurysm

We present a patient with a rare vascular emergency of iatrogenic right ulnar artery pseudoaneurysm presented as an expanding hematoma with right forearm compartment syndrome following a percutaneous coronary intervention done to place stent in the left anterior descending artery through right transulnar approach (radial nondominant). A 71-year-old female was referred with a mass on the flexor aspect of the right forearm associated with severe localized pain, tenderness, and weakness of distal forearm and hand. Investigations had revealed a right ulnar artery pseudoaneurysm. Ultrasonography of the right forearm demonstrated a pseudoaneurysm with thrombus formation arising from the right ulnar artery and using a hand Doppler, no blood flow detected distal to the swelling. Surgical repair by an open approach was done to remove the hematoma and the ulnar artery puncture site was repaired. The postoperative period was uneventful.

A New Utilization Area of Near-Infrared Fluorescence Imaging

Hypothenar hammer syndrome (HHS) is a rare traumatic vascular disease, which is characterized by pain and cold insensitivity in the areas fed by ulnar artery. Computerized tomography angiography (CTA) is the gold standard for the accurate diagnosis of it. Less invasive tests that are used to make decisions regarding the application of angiography, which is an invasive imaging method, have been reported in the literature. In this study, an indocyanine green-enhanced near-infrared fluorescence imaging system is used for the diagnosis of a patient with HHS who was not properly diagnosed with CTA. Although CTA is still considered as the gold standard for the diagnosis of upper extremity vascular insufficiencies, indocyanine green-enhanced fluorescence imaging, being an easily applicable and lacking of radiation exposure, should be considered first before CTA.

Surgical management of a delayed post-traumatic saccular aneurysm of the radial artery.

Post‐traumatic aneurysm of the radial artery is a rare and often misdiagnosed vascular lesion of the wrist. Radial artery ligation can lead to excellent results if Allen test confirmed that ulnar artery is the dominant feeding artery to the hand.

Thrombosis of Aberrant Right Subclavian Artery Presenting As Myocardial Infarction

Aberrant right subclavian artery (ARSA) is a rare anomaly, in which the right subclavian artery arises directly from the aortic arch instead of originating from the brachiocephalic artery. This anomaly should be taken into consideration during surgical procedures around the esophagus, such as esophagectomy. Any unintentional injury of this artery during surgical procedures could be extremely life-threatening. The patient was an 88-year-old male, known case of hypertension, CAD, COPD, presented with the chief complaint of chest pain for 2 days associated with the history of right-hand weakness and numbness for 1 week. ECG has done suggestive of Sinus Rhythm with LBBB Trop I – 6.1 ng/ml Coronary Angiography LMCA- Normal LAD- Mid LAD 80% stenosis LCX- Proximal 99-100% occluded RCA- normal CT ANGIO right upper limb done findings revealed anomalous retro esophageal course of right subclavian artery with narrowing at its origin and a small thrombus in juxta osteal segment. Thrombus of 6.7 cm long segment of the distal third of right brachial artery with the reformation of brachial artery at the level of elbow joint along with thrombosis of right ulnar artery at a short distance from its origin. Keywords: Aberrant right subclavian artery; Thrombosis; Myocardial infarction.

Is Hyperspectral Imaging Suitable for Assessing Collateral Circulation Prior Radial Forearm Free Flap Harvesting? Comparison of Hyperspectral Imaging and Conventional Allen's Test.

(1) Background: This cross-sectional study aims to compare a new and non-invasive approach using hyperspectral imaging (HSI) with the conventional modified Allen’s test (MAT) for the assessment of collateral perfusion prior to radial forearm free flap harvest in healthy adults. (2) HSI of the right hand of 114 patients was recorded. Here, three recordings were carried out: (I) basic status (perfusion), (II) after occlusion of ulnar and radial artery (occlusion) and (III) after releasing the ulnar artery (reperfusion). At all recordings, tissue oxygenation/superficial perfusion (StO2 (0–100%); 0–1 mm depth), tissue hemoglobin index (THI (0–100)) and near infrared perfusion index/deep perfusion (NIR (0–100); 0–4 mm depth) were assessed. A modified Allen’s test (control) was conducted and compared with the HSI-results. (3) Results: Statistically significant differences between perfusion (I) and artery occlusion (II) and between artery occlusion (II) and reperfusion (III) could be observed within the population with a non-pathological MAT (each <0.001). Significant correlations were observed for the difference between perfusion and reperfusion in THI and the height of the MAT (p < 0.05). Within the population with a MAT >8 s, an impairment in reperfusion was shown (each p < 0.05) and the difference between perfusion and reperfusion exhibited a strong correlation to the height of the MAT (each p < 0.01). (4) Conclusions: The results indicate a reliable differentiation between perfusion and occlusion by HSI. Therefore, HSI could be a useful tool for verification of the correct performance of the MAT as well as to confirm the final diagnosis, as it provides an objective, reproducible method whose results strongly correlate with those obtained by MAT. What is more, it can be easily applied by non-medical personnel.

A Case of Rumpel-Leede Phenomenon in Ulnar Artery Catheterization

Rumpel - Leede phenomenon (RLP) was described as early 1909 by Theodore Rumpel and by Stockbridge Leede in 1911 in patients suffering from scarlet fever. Acute development of petechial rashes distal to the application of blood flow occlusive devices such as a blood pressure cuff or tight wrapped bandage, is a typical finding in this phenomenon. Multiple isolated cases of RLP associated with coronary angiogram have been reported. In this report, we present a case of a 53-year-old male who developed RLP after percutaneous intervention of the proximal-mid left anterior descending artery after application of a sphygmomanometer cuff to contain a right forearm hematoma and application of a trans-radial band. We here discuss the etiopathogenesis and management of RLP that develops post coronary angiogram.

Lessons Learned After 760 Neurointerventions via the Upper Extremity Vasculature: Pearls and Pitfalls.

The radial approach has been gaining more widespread use by neurointerventionalists fueled by data from the cardiology literature showing better safety and overall reduced morbidity. To present our institution's experience with the radial approach for neuroendovascular interventions in 614 consecutive patients who underwent a cumulative of 760 procedures. A retrospective analysis was performed and identified neuroendovascular procedures performed via the upper extremity vasculature access site. Amongst 760 procedures, 34.2% (260) were therapeutic, and 65.7% (500) were nontherapeutic angiograms. Access sites were 71.5% (544) via a conventional radial artery, 27.8% (211) via a distal radial artery, 0.5% (4) via an ulnar artery, and 0.1% (1) via the brachial artery. Most of the procedures (96.9%) were performed via the right-sided (737), 2.9% (22) via the left-sided, and 0.1% (1) via a bilateral approach. Major access site complications occurred at a rate of 0.9% (7). The rate of transfemoral conversion was 4.7% (36). There was a statistically higher incidence of transfemoral conversion when repeat procedures were performed using the same access site. Also, there was no significant difference between nontherapeutic procedures performed using the right and left radial access, and conventional versus distal radial access. Procedural metrics improved after completion of 14 procedures, indicating a learning curve that should be surpassed by operators to reach optimal outcomes. Radial artery catheterization is a safe and effective means of carrying out a wide range of neuroendovascular procedures associated with excellent clinical outcomes and an overall low rate of periprocedural complications.

Anatomy of septocutaneous blood vessels of the anterior forearm.

Aim To measure a calibre of radial and ulnar septocutaneous perforators at the anterior forearm, and to count its number in proximal, middle and distal thirds. Methods The study was conducted on 50 fresh amputated forearms (trauma, tumours) in the period between January 2012 and December 2021. Forearms were collected from several hospitals in Belgrade, and analysed at the Institute of Anatomy, Medical School, University of Belgrade, Serbia. Injection of ink-gelatin and fine dissection of autopsy material was performed on 30 forearms, and corrosion method with injecting methyl methacrylate for 3D analysis on the other 20 forearms. Results A mean calibre of septocutaneous perforators on the radial artery was 0.53±0.46 mm (0.2-0.85). Averagely, there were 8.1 radial artery septocutaneous perforators - two perforators on the proximal third, 3.7 on the middle third, and 2.7 on the distal third. The mean calibre of ulnar artery perforators was 0.65±0.35 mm (0.18-1.8). The average number of septocutaneous perforators of the ulnar artery was 5.6; 1.2 on the proximal third, two on the middle third, and 2.2 on distal third. Conclusion Determination of the origin, calibre and spreading directions of the arterial septocutaneous perforators on the anterior forearm provide quantification of data about arborisation of radial and ulnar septocutaneous perforators at the anterior forearm. Clinical relevance of those anatomical data is in defining of safe locations and dimensions of forearm fasciocutaneous flaps in plastic surgery.

Sonographic Evaluation of a Perpetual Penetrating Retained Wood Splinter, Ulnar Artery Occlusion, and Soft Tissue Swelling in the Left Arm CME credit June 2021

Sonographic Evaluation of a Perpetual Penetrating Retained Wood Splinter, Ulnar Artery Occlusion, and Soft Tissue Swelling in the Left Arm CME credit June 2021

Infrequent disposition of the first metacarpal artery related to anastomoses of the superficial and deep systems of the hand.

There is an infrequent disposition of the first metacarpal artery which results in an anastomosis with the common palmar digital artery of the second space, forming an anastomotic system between the deep radial system and the superficial ulnar system. The radial system in turn, through the first dorsal interosseous artery, anastomoses with a collateral of the common palmar digital artery of the second space, ending as the ulnar palmar digital artery of the thumb and establishing a second anastomotic system. A third anastomosis is established in one case, between the common palmar digital artery of the fourth space and the fourth metacarpal artery. To this may be added the classic anastomosis between the superficial branch of the ulnar artery and the deep branch of the radial artery, i.e. the deep palmar arch.

Blood flow changes in the forearm arteries after ultrasound-guided costoclavicular brachial plexus blocks: a prospective observational study

BackgroundAn increase in blood flow in the forearm arteries has been reported after brachial plexus block (BPB). However, few studies have quantitatively analysed the blood flow of the forearm arteries after BPB or have studied only partial haemodynamic parameters. The purpose of the present study was to comprehensively assess blood flow changes in the distal radial artery (RA) and ulnar artery (UA) after BPB performed via a new costoclavicular space (CCS) approach using colour Doppler ultrasound.MethodsThirty patients who underwent amputated finger replantation and received ultrasound-guided costoclavicular BPB were included in the study. The haemodynamic parameters of the RA and UA were recorded before the block and 10 min, 20 min, and 30 min after the block using colour Doppler ultrasound to determine the peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vmean), pulsatility index (PI), resistance index (RI) and area. The volumetric flow rate (VFR) was calculated using the formula Q = area×Vmean. The aforementioned parameters were compared not only before and after the BPB but also between the RA and UA.ResultsCompared with those of the respective baselines, there was a significant increase in the PSV, EDV, Vmean, area, and VFR and a significant decrease in the PI and RI of the RA and UA 10 min, 20 min, and 30 min post-block. The increase 30 min post-block in EDV (258.68 % in the RA, 279.63 % in the UA) was the most notable, followed by that in the Vmean (183.36 % in the RA, 235.24 % in the UA), and the PSV (139.11 % in the RA, 153.15 % in the UA) changed minimally. The Vmean and VFR of the RA were significantly greater than those of the UA before the BPB; however, there was no significant difference in the VFR between the RA and UA after the BPB.ConclusionsA costoclavicular BPB can increase blood flow in the forearm arteries. The RA had a higher volumetric flow rate than the UA before the BPB; however, the potential blood supply capacity of the UA was similar to that of the RA after a BPB.Trial registrationThis study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/searchproj.aspx, clinical trial number: ChiCTR 1900023796, date of registration: June 12, 2019)

MO659INITIAL EXPERIENCE OF PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION

Abstract Background Arteriovenous fistulas (AVFs) for hemodialysis are inconstantly used primarily due to problems with maturation and early thrombosis. An endovascular approach -without open surgery- for fistula creation offers another option for establishing a reliable vascular access. By this procedure, a arteriovenous fistula is created in the area of the cubital fossa in the deep vascular system, either between the ulnar artery and the accompanying vein or the radial artery and radial vein and uses the perforating vein at the level of the elbow to transfer blood to the superficial network of the arm. Aim To evaluate the safety, success and maturation rates of percutaneous arteriovenous fistula creation. Materials and Methods From February 2018 to June 2020 (28 months), 30 percutaneous arteriovenous fistulas (pAVF) using the WavelinQ device were created in 30 patients (male: 100%) with end stage kidney disease. Outcome measures were safety, defined as adverse events occurring within the first month of creation, success, defined as the ability to create an anastomosis between the vessels of interest and maturation rates, defined as the ability to perform at least one successful dialysis with the AVF. Secondary outcome measures included procedural complications, secondary procedures, time to cannulation, and AVF survival. Results All cases were performed as day procedures. 23 out of 30 patients (70%) were already on hemodialysis carrying a permanent central venous catheter. Main comorbidities were hypertension (21/30; 70%), diabetes (15/30; 50%) while 11/30 (30.5%) were smokers. Success was 100% (30/30). Mean follow-up was 547 days (range: 14-1071 days). In one case a pseudoaneurysm of the brachial artery was created immediately after sheath removal and in another case, an aneurysm of the AVF anastomosis was observed 17 days post-procedure and AVF was legated with a covered stent placed in the arterial part. In all, 26/30 AVFs (86.6%) were successfully cannulated. Mean time to cannulation was 61.3 days. Another one failed after maturation during the follow-up period. In total, 15 interventions were needed to achieve maturation (15/26; 0.58 procedures per AVF). 5 maintenance endovascular interventions were performed during the follow-up period (5/26; 19.2%). Mean time from cannulation to the end of follow up was 566.2 days (range: 135-1041 days). Conclusion Current analysis suggests that percutaneous AVF creation is safe, successfully performed with high maturation rates. Large scale prospective studies are needed to validate results.