Rofo 2017; 189(S 01): S1-S124
DOI: 10.1055/s-0037-1600294
Vortrag (Wissenschaft)
Interventionelle Radiologie
Georg Thieme Verlag KG Stuttgart · New York

Percutaneous creation of an arteriovenous fistula (pAVF) for hemodialysis access

C Radosa
1   Universitätsklinikum Dresden, Radiologie, Dresden
,
N Weiss
2   Universitätsklinikum Dresden, Universitäts GefäßCentrum und Medizinische Klinik III, Dresden
,
T Hofmockel
1   Universitätsklinikum Dresden, Radiologie, Dresden
,
J Radosa
3   Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg
,
M Laniado
1   Universitätsklinikum Dresden, Radiologie, Dresden
,
R Hoffmann
1   Universitätsklinikum Dresden, Radiologie, Dresden
› Author Affiliations
Further Information

Publication History

Publication Date:
23 March 2017 (online)

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Zielsetzung:

Standard for vascular access for hemodialyis is surgical creation of a radio-cephalic fistula. If not suitable, a brachiocephalic or -basilic fistula may be created, which, however, is associated with a higher complication rate. Recently, an endovascular approach for ulnar-ulnar fistula creation (EndoAVF) had been developed, which may be an alternative to surgical upper arm dialysis fistula. We aimed to study feasibility, technical success, early complications and outcome of this novel treatment option.

Material und Methodik:

Between July 2015 and February 2016 eight patients were included in this prospective observational study. Indications for pAVF were confirmed by a multidisciplinary vascular board upon contraindication for cimino fistula creation. Patients were included after a pretherapeutic ultrasound showing patent brachial and ulnar arteries and veins of adequate size, perforating veins between deep and superficial veins in the cubital area, and no ipsilateral central venous stenosis. Patient characteristics, technical success, duration of intervention, total patient radiation dose, complication rates, time to maturation of pAVF and clinical effectiveness at 6 month were assessed.

Ergebnisse:

From eight patients included in the study, creation of pAVF was successful in all cases. Median duration of intervention was 60 min (range: 40 – 80) and decreased over time from 80 minutes to 40 – 50 minutes. There was one minor intraoperative complication and no postoperative complications. Median time to pAVF maturation were 63 days (range: 26 – 137 d). One patient was lost to follow-up after the first monitoring. Due to the remaining seven patients hemodialysis was started without problems. Patency after four-months was 100%.

Schlussfolgerungen:

EndoAVF seems to be feasible and safe for the creation of arteriovenous fistula – showing fast maturation. Bigger sample sizes and longer follow-ups are needed to prove the comparability to surgical dialysis access creation.