Inside Access provides interviews and behind-the-scenes on open access articles from the Journal of Vascular and Interventional Radiology. Read the full article on JVIR.
Two-year cumulative and functional patency after creation of endovascular arteriovenous hemodialysis fistulae.
Klein E, Rajan DJ, Maalouf T, Repko B.
Tell us about you, your research team and institution.
Erez Klein, MD: I’m currently an attending physician at Moffitt Cancer Center in Tampa, Florida. At the time of research, in 2022–2023, I was a VIR fellow at University Health Network (Toronto General, Mount Sinai Hospital Toronto, Ontario, Canada) and was honored to participate as first author in this publication working under Dheeraj Rajan, MD, who has decades of experience with hemodialysis fistulas from the IR perspective. Other personal interests of research include patient experience during minimally invasive procedures in IR utilizing augmented reality (AR). Currently, I am establishing an AR service at Moffitt Cancer Center IR department.
What was the focus of your study?
EK: The focus of our study was to evaluate the cumulative and functional patency of endovascular arteriovenous (AV) hemodialysis fistulas, specifically with WavelinQ device. Endovascular AV fistula creations are considered new to the hemodialysis domain compared to surgical AV fistulas done prior. Our aim was to provide a good cumulative and functional patency of endovascular AV fistulas, increasing the awareness of its usage to both clinical providers and our patients.
Elsevier
Why did you set out to research this topic?
EK: We have found that in regard to endovascular AV fistula creation, there is an insufficient amount of literature published regarding patency. Some literature has been published in relation methodology; however, it was important to us as a group to emphasize that endovascular AV fistula creation is a minimally invasive procedure that works, remains patent and our patients benefit from it to the highest standards. The procedure is minimally invasive, with no need for surgery. Recovery time is minimal with most patients developing an adequate fistula to be used for hemodialysis. We followed our patients and found impressive cumulative and functional capacity, as expected.
How do you think this research could impact treatment, practice or clinical processes?
EK: In our opinion, endovascular AV fistula creation will become gold standard within the upcoming years. This procedure is safe, nonsurgical, has very low complication rates and has been proven to work for the majority of the patients. Furthermore, patients in need of hemodialysis who are not surgical candidates due to other comorbidities are now offered a minimally invasive approach for hemodialysis fistula creation without surgery. Nevertheless, further studies should be encouraged to support our findings, shifting the current surgical avenue into the new and more appealing endovascular avenue.
What are the next steps? Any additional research planned?
EK: Our goal is to seek long-term functional and cumulative patency for endovascular AV fistula creation as well as joining forces with other institutions making a bigger cohort study. To become gold standard, more publications are needed for the sake of education and results transparency.
Researchers’ key takeaways:
- Endovascular AV fistula creation is a minimally invasive procedure with an excellent technical success rate and should be encouraged in more institutions.
- High cumulative and functional patency with endovascular AV fistulas using the WavelinQ device.
- We found a very low complication rate, allowing for a safe and secure procedure for our patients.
- We encourage more prospective studies to be done and collaborate in multi-centers for improved patient care.
