Endovascular AV fistula for dialysis access demonstrates functionality, patient satisfaction
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Published findings report that, for vascular access in hemodialysis, the creation of an arteriovenous fistula using an endovascular approach — which avoids an open surgical procedure — was associated with patency at 2 years and a high level of patient satisfaction.
In a related press release, lead author Gerald A. Beathard, MD, PhD, of the University of Texas Medical Branch, said, “The dramatic difference in durability between the endovascular fistulas and the surgically created ones is striking.”
According to the research article, the endovascular AVF “has the beneficial attributes of the [proximal radial artery] PRA-AVF while adding the advantages of avoiding the trauma of surgery by allowing a percutaneous approach performed under local/regional anesthesia. In addition, the location of the anastomosis and lack of an incision significantly expands the cannulation zone of the access in many patients.”
Using data from five U.S. vascular access programs (totaling 105 patients with endovascular arteriovenous fistula), researchers calculated 2-year cumulative patency rates. Patient satisfaction was determined through an assessment survey and a focus group.
Researchers found a physiologically mature arteriovenous fistula, defined as blood flow of 500 mL/minute or greater and a target vein internal diameter of 4 mm or more, was obtained in 98% of participants, while a clinically functional arteriovenous fistula (supporting two-needle dialysis) was demonstrated in 95%. During the study period, there were eight cases of access failure.
Researchers determined the cumulative patency rate of the endovascular AV fistula to be 97.1%, 93.9%, 93.9% and 92.7% at 6, 12, 18 and 24 months, respectively.
Regarding patient responses, 95% were pleased by the lack of pain and 93% rated overall satisfaction as “excellent” or “very good.” The focus group revealed that patients were satisfied with the lack of an open surgical procedure and they had an improved body image impression compared with patients who had a surgically created AV fistula.
“Although patients with a functioning AVF report a better quality of life than those with other types of vascular access, a significant number of patients refuse to have an AVF created,” the researchers wrote. “Patient satisfaction and their perception of quality of life are important. Body image related to disfigurement associated with a surgically created AVF, pain associated with surgery and failure of maturation requiring additional interventions have been noted as important factors in patients’ perception of their vascular access. Patient experience with the [endovascular AVF] enAVF reflected a positive response to these issues.” – by Melissa J. Webb
Disclosures: Beathard reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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