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NEAT: Endovascular arteriovenous fistula benefits patients needing hemodialysis
Radiofrequency magnetic catheter-based systems can potentially be used to create an endovascular arteriovenous fistula for hemodialysis access, according to results published in the American Journal of Kidney Disease.
The magnet-based endovascular technique (everlinQ endoAVF System, TVA Medical) is an alternative that has minimal complications and prevents the need for open surgery, researchers wrote.
“We previously reported proof of concept, developmental work regarding a novel magnet-based endovascular technology to create an [arteriovenous fistula]. However, this work was limited by the single-center experience in a select population: young patients without significant vascular disease,” Charmaine E. Lok, MD, FRCPC, medical director of the hemodialysis program at University Health Network-Toronto General Hospital and senior scientist at the Toronto General Hospital Research Institute, and colleagues wrote. “Thus, the real-world use of this technology in a range of operators and patients with chronic kidney disease is untested and unknown.”
The researchers conducted an international, prospective clinical study to evaluate the safety and efficacy of an endovascular technique with multiple operators in a broad chronic kidney disease population.
The NEAT trial included 80 non-dialysis-dependent and dialysis-dependent patients referred for vascular access creation across nine centers in Canada, Australia and New Zealand.
Endovascular arteriovenous fistulas were created in 98% of patients, 8% of whom had serious procedure-related adverse events; a device-related event occurred in one patient (2%).
Eighty-seven percent of patients were physiologically suitable for dialysis (mean brachial artery flow, 918 mL/min; endovascular arteriovenous fistula vein diameter, 5.2 mm).
Among those who received dialysis, endovascular arteriovenous fistula functional usability was 64%.
At 1 year, primary patency was 69% and cumulative patency was 84%, according to the researchers.
“The NEAT study results show that the everlinQ endovascular approach can produce fistulas for hemodialysis, with an acceptable safety profile,” Lok said in a press release. “This unique approach offers clinicians and chronic kidney disease patients another option for fistula creation that is minimally invasive.” – by Dave Quaile
Disclosure: The study was supported by TVA Medical. One researcher reports being an equity stock owner of TVA Medical.