Our Summary

Patients with kidney failure often require a treatment called hemodialysis, which needs good access to the bloodstream. The traditional way to create this access is through a surgical procedure called a radiocephalic fistula. However, this study describes a new, less invasive technique called an endovascular upper arm fistula (endoAVF).

Over a period of about eight months, this new procedure was performed on eight patients who weren’t suitable for the traditional surgery. The patients were chosen based on certain criteria, including the condition of their blood vessels. The study examined the success of the procedure, the amount of radiation the patients were exposed to, the rate of complications, and how long it took for the fistula to mature (become ready for use).

The new procedure was successful in all eight patients. One patient experienced a minor complication during the procedure, but there were no complications after the procedure. On average, it took about two months for the fistulas to mature. One patient was lost to follow-up, but the remaining seven were able to start hemodialysis without any issues. Six months after the procedure, all of the fistulas were still working well.

The study concludes that the endoAVF procedure appears to be a safe and effective way to create the necessary access for hemodialysis. However, more research is needed to compare this new technique with the traditional surgery, and to determine the long-term results.

FAQs

  1. What is the difference between a radiocephalic fistula and an endovascular upper arm fistula (endoAVF)?
  2. How long does it typically take for the fistulas to mature using the endoAVF procedure?
  3. How does the success rate and complication rate of the endoAVF procedure compare to the traditional surgery?

Doctor’s Tip

A doctor might advise a patient undergoing AV fistula creation to follow all post-procedure care instructions carefully, including keeping the area clean and dry, avoiding heavy lifting or strenuous activity with the arm, and monitoring for any signs of infection or complications. Additionally, they may recommend regular follow-up appointments to ensure the fistula is maturing properly and functioning well for hemodialysis.

Suitable For

Patients who are typically recommended for AV fistula creation include those with kidney failure who require hemodialysis. This can include patients with chronic kidney disease, end-stage renal disease, or other kidney-related conditions. Patients who have suitable blood vessels for the procedure are also good candidates for AV fistula creation. Additionally, patients who may not be eligible for traditional surgical procedures due to various factors may benefit from the less invasive endovascular upper arm fistula procedure. Overall, the decision to recommend AV fistula creation is based on individual patient factors and the recommendation of the healthcare provider overseeing the patient’s care.

Timeline

Before AV fistula creation:

  • Patient is diagnosed with kidney failure and requires hemodialysis
  • Patient undergoes evaluation to determine suitability for traditional surgical AV fistula creation
  • Patient may be deemed unsuitable for surgery due to various factors, such as poor blood vessel condition
  • Patient is selected for endovascular upper arm fistula (endoAVF) procedure
  • Procedure is performed, taking about two months for the fistula to mature
  • Patient is monitored for complications and success of the procedure

After AV fistula creation:

  • Patient is able to start hemodialysis without issues
  • Fistula continues to mature and is working well six months after the procedure
  • Patient continues to be monitored for long-term results and potential complications
  • Research is ongoing to compare the new endoAVF procedure with traditional surgical methods and determine its effectiveness in the long term.

What to Ask Your Doctor

Some questions a patient should ask their doctor about AV fistula creation include:

  1. What are the potential risks and benefits of the endovascular upper arm fistula (endoAVF) procedure compared to traditional surgery?
  2. Am I a suitable candidate for the endoAVF procedure based on the condition of my blood vessels?
  3. How long will it take for the fistula created with the endoAVF procedure to mature and be ready for use?
  4. What is the success rate of the endoAVF procedure in terms of creating a functioning access for hemodialysis?
  5. What are the potential complications associated with the endoAVF procedure, both during and after the procedure?
  6. How does the amount of radiation exposure during the endoAVF procedure compare to traditional surgery?
  7. What follow-up care will be required after the endoAVF procedure to ensure the fistula continues to function properly?
  8. Are there any long-term studies or data available on the effectiveness of the endoAVF procedure compared to traditional surgery for creating AV fistulas?
  9. How soon after the endoAVF procedure can I start hemodialysis treatment?
  10. Are there any specific lifestyle changes or precautions I should take after undergoing the endoAVF procedure to ensure the success of the fistula?

Reference

Authors: Radosa CG, Radosa JC, Weiss N, Schmidt C, Werth S, Hofmockel T, Plodeck V, Gatzweiler C, Laniado M, Hoffmann RT. Journal: Cardiovasc Intervent Radiol. 2017 Oct;40(10):1545-1551. doi: 10.1007/s00270-017-1750-x. Epub 2017 Aug 7. PMID: 28785804