Endovascular arteriovenous fistula creation

Last revised by Yuranga Weerakkody on 5 Jun 2021

Citation, DOI, disclosures and article data

Citation:

Sirakaya M, Weerakkody Y, Murphy A, Endovascular arteriovenous fistula creation. Reference article, Radiopaedia.org (Accessed on 24 Apr 2024) https://doi.org/10.53347/rID-78245

DOI:

https://doi.org/10.53347/rID-78245

Permalink:

https://radiopaedia.org/articles/78245

rID:

78245

Article created:

1 Jun 2020, Mert Sirakaya

Disclosures:

At the time the article was created Mert Sirakaya had no recorded disclosures.

View Mert Sirakaya's current disclosures

Last revised:

5 Jun 2021, Yuranga Weerakkody ◉

Disclosures:

At the time the article was last revised Yuranga Weerakkody had no recorded disclosures.

View Yuranga Weerakkody's current disclosures

Revisions:

4 times, by 3 contributors - see full revision history and disclosures

Systems:

Vascular, Interventional

Sections:

Interventional Radiology

Tags:

endovascular, fistula, arteriovenous fistula, dialysis, haemodialysis access

Synonyms:

Endovascular AVF
Percutaneous arteriovenous fistula
Percutaneous AVF

Endovascular arteriovenous fistula creation is a recently developed minimally invasive alternative for the creation of arteriovenous fistulae for haemodialysis access.

Catheter-based technology and image guidance in the form of ultrasound and fluoroscopy is utilized create a side-to-side anastomosis between an artery and a vein by using a combination of heat, pressure and radiofrequency electrodes. There are currently a few devices available, and specific technique differs based upon the device used. Current endovascular techniques create arteriovenous fistulae in the proximal forearm ^1,2,3.

Fistulae may have multiple venous outflows resulting in a varying degree and distribution of venous outflow dilatation. Additional interventions can subsequently direct flow into a single venous outflow channel ¹. Specific consideration for endovascular arteriovenous fistulae creation is the presence and caliber of the perforator vein near the antecubital fossa ^1,2,3.

Outcomes

In contrast to surgical arteriovenous fistulae creation, endovascular techniques can be performed in a day case setting without the need for a surgical theater. Procedures are performed under local anesthesia and/or conscious sedation with the use of small incisions, theoretically allowing for quicker healing times. Further interventions may be required based upon the individual patient ^1,2,3.

Evidence suggests that endovascular arteriovenous fistulae creation is a comparable alternative to surgical techniques and does not preclude surgical arteriovenous fistulae creation in the majority of patients. Endovascular approaches have been observed to have a high technical success rate and have demonstrated high rates of subsequent patency ^1,2,3.

Due to the reduction in surgical trauma (a risk factor for neointimal hyperplasia), endovascular techniques may reduce the need for subsequent re-intervention ^1,2,3.

Currently, further comparative studies and longer-term data are required to fully evaluate the utility of this emerging technique in the management of patients' requiring dialysis access ^1,3.