Endovascular arteriovenous fistulas— are they the answer we haven’t been looking for?

ABSTRACT

Introduction

Surgically created arteriovenous fistulas are the accepted gold standard for the establishment of hemodialysis access in patients requiring dialysis. However, primary and maturation failures may limit their usage. Recent advances in endovascular technology have resulted in the creation of devices for endovascular arteriovenous fistula formation. These devices may offer an additional or alternative approach to fistula formation in patients with end-stage kidney disease.

Areas covered

This review describes the limitations of surgical arteriovenous fistulas and the endovascular devices currently available. The review covers initial trial data and subsequent studies examining their use.

Expert opinion

Early results achieved with endovascular fistula formation are encouraging. Current limitations of this technology include anatomic suitability and a high rate of re-interventions required to establish maturity. Greater uptake of the technology will also require a review of long-term outcomes in larger patient cohorts.

KEYWORDS:

• Arteriovenous fistula
• hemodialysis
• dialysis access
• endovascular
• interventional radiology

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

One peer reviewer has acted as a consultant for Avenu Medical. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.