Is Endovascular Arteriovenous Fistula a Feasible Alternative for Hemodialysis Patients?

Introduction: For hemodialysis (HD) patients, the selection of vascular access is a crucial factor that significantly affects morbidity and mortality. Historically, native arteriovenous fistulas (AVFs) have been established using surgical techniques. However, devices facilitating percutaneous endovascular arteriovenous fistula (endoAVF) formation have recently been introduced in clinical practice, showing promising initial evidence. The primary objectives were technical success, efficacy, and cannulation rates. The secondary objectives included primary and cumulative patency, safety, and the number of procedures required to maintain fistula patency. Methods: A prospective, single-center, single-arm study included all patients who underwent endoAVF creation using the WavelinQ (TM) EndoAVF System at a University Hospital between December 2021 and August 2023. Results: A total of 20 patients who underwent an endoAVF were included. Technical success was 100%. In total, 75% (15) of the endoAVFs met the criteria for physiological suitability. The cannulation rate was 66% (10/15) for endoAVFs that reached physiological suitability. At 6 months of follow-up, the primary and cumulative patency rates were 65% and 75%, respectively; at 12 months, these were 50% and 70%, respectively. Serious adverse events were not observed. The reintervention rate was 0.33 procedures/patient-year. Conclusion: Based on our experience, creating AVFs using the WavelinQ 4-F EndoAVF System is safe and effective, with high technical success rates and acceptable patency and reintervention rates.