Feasibility for arteriovenous fistula creation with Ellipsys®

Gilbert Franco, Alexandros Mallios, Pierre Bourquelot, Hadia Hebibi, William Jennings, Benoit Boura, Gilbert Franco, Alexandros Mallios, Pierre Bourquelot, Hadia Hebibi, William Jennings, Benoit Boura

Abstract

Objective: To investigate the feasibility of percutaneous arteriovenous fistula creation in consecutive patients screened for first access creation.

Methods: Prospective study of ultrasound mapping based on the following minimal anatomic requirements: a patent proximal radial artery and adjacent elbow perforating vein with straight trajectory, each greater than or equal to 2 mm in diameter and within 1.5 mm of each other. In addition, the same population was evaluated for feasibility of a distal radiocephalic fistula established.

Results: One hundred consecutive patients were examined between November 2018 and January 2019. Sixty-seven were male (67%) and mean age was 61 years. Sixty-three patients (63%) and a total of 100 limbs (50%) were found to be eligible for a percutaneous fistula creation with Ellipsys®. Thirty-seven percent of patients were ineligible because of the absence of both median cephalic and median cubital veins (15%), absence or inadequate elbow perforating vein and/or smaller than 2 mm proximal radial artery (14%), and/or distance greater than 1.5 mm (8%). We found suitable vessels for a surgical distal fistula creation in 91 extremities (45%), but this percentage dropped to 17% in patients over 70 years old. Among the 100 limbs eligible for percutaneous arteriovenous fistula, only 30 (30%) were eligible for radiocephalic arteriovenous fistula.

Conclusion: More than 60% of patients were eligible for Ellipsys. The absence of veins at the elbow and a large distance between vessels were the most common limiting factors. Less than one half of the patients were candidates for surgical fistula and this percentage dropped significantly for older individuals.

Keywords: Percutaneous arteriovenous fistula; arteriovenous fistula; duplex scan; perforating vein; proximal radial artery; radiocephalic; ultrasound.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drs Mallios and Jennings are consultants and shareholders for Avenu Medical.

Figures

Figure 1.
Figure 1.
Duplex scan of antecubital fossa. Note the proximity between (1) proximal radial artery (PRA) and the (2) elbow perforating vein (EPV).

References

    1. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 2007; 49(2 Suppl 2): S12–154. PMID: 17276798.
    1. Brescia MJ, Cimino JE, Appel K, et al. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275: 1089–1092.
    1. Zonnebeld N, Maas TMG, Huberts W, et al. Pre-operative duplex ultrasonography in arteriovenous fistula creation: intra- and inter-observer agreement. Eur J Vasc Endovasc Surg 2017; 54(5): 613–619.
    1. Palmes D, Kebschull L, Schaefer RM, et al. Perforating vein fistula is superior to forearm fistula in elderly haemodialysis patients with diabetes and arterial hypertension. Nephrol Dial Transplant 2011; 26(10): 3309–3314.
    1. Mallios A, Jennings WC, Boura B, et al. Early results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System. J Vasc Surg 2018; 68(4): 1150–1156.
    1. Hull JE, Elizondo-Riojas G, Bishop W, et al. Thermal resistance anastomosis device for the percutaneous creation of arteriovenous fistulae for hemodialysis. J Vasc Interv Radiol 2017; 28(3): 380–387.
    1. American Institute of Ultrasound in Medicine. AIUM standards and guidelines for the accreditation of ultrasound practices, 31 October 2015,
    1. Schmidli J, Widmer MK, Basile C, et al. Vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55(6): 757–818.
    1. Ten Berge MG, Yo TI, Kerver A, et al. Perforating veins: an anatomical approach to arteriovenous fistula performance in the forearm. Eur J Vasc Endovasc Surg 2011; 42(1): 103–106.
    1. Lomonte C, Basile C. On the phenomenology of the perforating vein of the elbow. Semin Dial 2009; 22(3): 300–303.
    1. Valentino J, Funk GF, Hoffman HT, et al. The communicating vein and its use in the radial forearm free flap. Laryngoscope 1996; 106: 648–651.
    1. Gracz KC, Ing TS, Soung LS, et al. Proximal forearm fistula for maintenance hemodialysis. Kidney Int 1977; 11(1): 71–75.
    1. Konner K, Hulbert-Shearon TE, Roys EC, et al. Tailoring the initial vascular access for dialysis patients. Kidney Int 2002; 62(1): 329–338.
    1. Weyde W, Kusztal M, Krajewska M, et al. Radial artery-perforating vein fistula for hemodialysis. Am J Kidney Dis 2007; 49(6): 824–830.
    1. Bruns S, Jennings W. Proximal radial artery as inflow site for native arteriovenous fistula. J Am Coll Surg 2003; 197(1): 58–63.
    1. Jennings WC. Creating arteriovenous fistulas in 132 consecutive patients: exploiting the proximal radial artery arteriovenous fistula: reliable, safe, and simple forearm and upper arm hemodialysis access. Arch Surg 2006; 141(1): 27–32; discussion 32.
    1. Toledo-Pereyra LH, Kyriakides GK, Ma KW, et al. Proximal radial artery – cephalic vein fistula hemodialysis. Arch Surg 1977; 112(2): 226–227.
    1. Palmes D, Kebschull L, Schaefer RM, et al. Perforating vein fistula is superior to forearm fistula in elderly haemodialysis patients with diabetes and arterial hypertension. Nephrol Dial Transplant 2011; 26(10): 3309–3314.
    1. Jennings W, Mallios A, Mushtaq N. Proximal radial artery arteriovenous fistula for hemodialysis vascular access. J Vasc Surg 2018; 67(1): 244–253.
    1. Hull JE, Jennings WC, Cooper RI, et al. The pivotal multicentre trial of ultrasound-guided percutaneous arteriovenous fistula creation for hemodialysis access. J Vasc Interv Radiol 2018; 29: 149–158.
    1. Hull JE, Kinsey EN, Bishop WL. Mapping of the snuffbox and cubital vessels for percutaneous arterial venous fistula (pAVF) in dialysis patients. J Vasc Access 2013; 14(3): 245–251.
    1. Jennings WC, Landis L, Taubman KE, et al. Creating functional autogenous vascular access in older patients. J Vasc Surg 2011; 53(3): 713–719.
    1. Karam L, Rawa M, Shoenfeld R, et al. Brachial vein transposition is a promising ultimate upper limb autologous arteriovenous angioaccess despite its many pitfalls. J Vasc Surg 2018; 67(1): 236–243.

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