Percutaneous proximal radial artery arteriovenous fistula creation for hemodialysis using the Ellipsys™ vascular access system

2014 ◽  
Vol 25 (3) ◽  
pp. S20 ◽  
Author(s):  
J.E. Hull ◽  
J.H. Velez ◽  
J.P. Martinez
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Access System

Non-randomized safety and performance evaluation of the av-Guardian vascular access system

2020 ◽  
Vol 21 (5) ◽  
pp. 665-672
Author(s):  
Chieh Suai Tan ◽  
Seck Guan Tan ◽  
Chi Leung Julian Wong ◽  
Bernard Wee ◽  
Weng Kin Wong ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
Successful Cannulation ◽  
Access System ◽  
Primary Endpoints ◽  
Number Of Patients ◽  
Blunt Needle ◽  
And Performance

Introduction: The ability to successfully cannulate the arteriovenous fistula reliably is a critical step in the delivery of hemodialysis therapy. The av-Guardian vascular access system (Advent Access, Singapore) is designed to overcome the technical barrier to establishing reliable blunt needle access in patients with mature arteriovenous fistula. Methods: This was a first-in-man, prospective, non-randomized trial (registered on the Australian New Zealand Clinical Trial Registry (ACTRN12617000501347)) performed to assess the safety and feasibility of achieving repeatable successful cannulation via av-Guardian vascular access system to facilitate blunt needling in patients with mature arteriovenous fistula. The primary endpoints of the study included rate of successful hemodialysis sessions via av-Guardian vascular access system cannulation over 3 months and safety of the implants. Results: A total of six patients (four patients with brachiocephalic and two with radiocephalic arteriovenous fistula) were enrolled in the study. A pair of av-Guardian vascular access system were implanted, one each at the arterial and venous cannulation sites, under local anesthesia. Overall, the rate of successful cannulation through the av-Guardian vascular access system over 3 months in 216 hemodialysis sessions was 98.1% (212/216) at the arterial site and 94.4% (204/216) at the venous site. Significantly, 90% and 85.5% of the cannulations at the arterial and venous site, respectively, were successful at first attempt. Blood flow rates within the arteriovenous fistula were unaffected by the devices. Conclusion: The results demonstrated the safety and feasibility of a subcutaneously implanted, extravascular device in achieving repeatable successful cannulation via a constant site, to facilitate blunt needling in matured arteriovenous fistula in limited number of patients.

Proximal Ulnar Artery Arteriovenous Fistula Inflow is an Uncommon but useful Vascular access Option

2017 ◽  
Vol 18 (6) ◽  
pp. 488-491 ◽  
Author(s):  
William C. Jennings ◽  
Alexandros Mallios
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Ulnar Artery ◽  
Allen’S Test ◽  
Brachial Vein ◽  
Anatomic Variants ◽  
Allen's Test ◽  
Doppler Evaluation

Introduction A proximal ulnar artery arteriovenous fistula (PUA-AVF) is a logical vascular access option when the distal ulnar artery is occluded or inadequate in addition to other specific vascular anatomic variants. This study reviews a series of patients where the proximal ulnar artery was used for AVF inflow in establishing a reliable autogenous access for these uncommon patients. Materials and methods All new patients referred for vascular access with a PUA-AVF created during an eight-year period were evaluated. In addition to physical and ultrasound examinations, all patients had an Allen's test performed augmented with Doppler evaluation of the palmer arch. Analysis placed these patients into three anatomic groups: 1) A dominant radial artery with distal ulnar artery occlusive disease; 2) No cephalic or basilic vein option with an isolated and intact brachial vein originating from the ulnar vein for later staged transposition; 3) A proximal radial artery ≤2 mm in diameter and a normal Doppler augmented Allen's test. Results PUA-AVFs were created in 32 new patients during an eight-year period. Primary and cumulative patency rates were 80% and 94% at 12 months and 55% and 81% at 36 months. Follow-up was 2-62 months (mean 14 months). No patients developed steal syndrome during the study period. Conclusions A PUA-AVF is a safe and reliable autogenous access. It is particularly important when the radial artery is the only or dominant arterial supply to the hand, in patients with small but patent radial arteries, and in selected individuals requiring a brachial vein transposition.

scholarly journals Proximal radial artery arteriovenous fistula for hemodialysis vascular access

2018 ◽  
Vol 67 (1) ◽  
pp. 244-253 ◽  
Author(s):  
William C. Jennings ◽  
Alexandros Mallios ◽  
Nasir Mushtaq
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Hemodialysis Vascular Access

scholarly journals Initial experience with the Ellipsys Vascular Access System for percutaneous arteriovenous fistula creation in adolescents: A case report

2021 ◽  
Vol 16 (3) ◽  
pp. 441-447
Author(s):  
Kevin S.H. Koo ◽  
Eric J. Monroe ◽  
Joseph Reis ◽  
Giridhar M. Shivaram ◽  
Raj Munshi
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Initial Experience ◽  
Access System

scholarly journals A novel technique of reimplantation of a radial artery that makes a hairpin turn to reduce the excessive vascular access flow in a dialysis patient

2020 ◽  
pp. 112972982092791
Author(s):  
Sotaro Katsui ◽  
Yoshinori Inoue ◽  
Nishizawa Masato ◽  
Kimihiro Igari ◽  
Toshifumi Kudo
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Brachial Artery ◽  
Chest Radiography ◽  
Small Diameter ◽  
Cardiac Preload ◽  
A New Technique ◽  
Artery Flow ◽  
Distal Radial Artery

We report a new technique called “reimplantation of an artery with a hairpin turn (RAHT)” to reduce excessive vascular access flow. A 73-year-old woman on dialysis consulted us for vascular surgery because of an increased cardiac preload. Chest radiography and echocardiography revealed an excessive shunt flow in the brachial artery (flow rate, 2336 mL/min). Vascular echo-Doppler of the left upper limb showed that the radial artery made a hairpin turn at the arteriovenous fistula (diameter, 9 mm). Diameters of the radial artery proximal and distal to the arteriovenous fistula were 5.4 and 3.7 mm, respectively. We ligated and divided the juxta-anastomosis proximal radial artery and subsequently created an end-to-side anastomosis between the proximal radial artery and the distal radial artery. The anastomosis ostium in the distal radial artery (the recipient) was formed with a 4-mm longitudinal and gently curved incision. We performed RAHT so that the small anastomosis between both arteries and the small diameter of the distal radial artery juxta-anastomosis segment could reduce the vascular access flow. The flow rates in the brachial artery were 500 mL/min just after surgery and 560 mL/min at 2 months after surgery. Postoperative chest radiography and echocardiography confirmed a decrease in cardiac preload. We believe that this RAHT technique could be useful as one of the options to reduce the flow in patients who have excessive vascular access flow with a radial artery that makes a hairpin turn.

scholarly journals Early results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System

2018 ◽  
Vol 68 (4) ◽  
pp. 1150-1156 ◽  
Author(s):  
Alexandros Mallios ◽  
William C. Jennings ◽  
Benoit Boura ◽  
Alessandro Costanzo ◽  
Pierre Bourquelot ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Access System ◽  
Early Results

scholarly journals Midterm results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System, technical recommendations, and an algorithm for maintenance

2020 ◽  
Vol 72 (6) ◽  
pp. 2097-2106 ◽  
Author(s):  
Alexandros Mallios ◽  
Pierre Bourquelot ◽  
Gilbert Franco ◽  
Hadia Hebibi ◽  
Hortence Fonkoua ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Midterm Results ◽  
Access System ◽  
Technical Recommendations

scholarly journals First experience with percutaneous arteriovenous fistula creation using the Ellipsys® vascular access system

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
A Isaak ◽  
A Mallios ◽  
L Gürke ◽  
T Wolff
Keyword(s):  
Radial Artery ◽  
Vascular Access ◽  
Success Rates ◽  
Basilic Vein ◽  
Technical Success ◽  
Upper Arm ◽  
Promising Alternative ◽  
Access System ◽  
The Creation ◽  
Vein Stenosis

Abstract Objective Percutaneous creation of arteriovenous fistulae (pAVF) has been developed as an alternative to the creation of an upper arm cephalic or basilic vein fistula. Several studies have shown high technical success rates and comparable time of maturation. To our knowledge, the technique has not been used in Switzerland before. Methods Prospective data collection of the first consecutive patients undergoing the creation of pAVF between April and July 2020 at two vascular surgery centres. Results Seven patients underwent pAVF creation with the Ellipsys® vascular access system under regional anaesthesia for maximum vasodilation. The procedures were performed entirely under sonographic control without the use of fluoroscopy. The cephalic or basilic vein was punctured and the puncture needle advanced under sonographic control through the cubital perforator vein into the proximal radial artery. The Ellipsys® catheter was advanced over a guidewire and activated to create the fistula between the proximal radial artery and the perforator vein. The fistula was further dilated with a 5mm PTA balloon. We achieved technical success in 6 patients. In one patient with small and spastic vessels, the needle could not be advanced into the radial artery. A conventional upper arm cephalic fistula was created during the same procedure. In three patients primary maturation was achieved and the cephalic vein or distal basilic vein could be punctured for dialysis without any adjunct procedures. One patient required three additional procedures before the fistula could be used successfully (additional angioplasty of the fistula, superficialisation of the basilic vein and correction of a cubital vein stenosis by excision and end-to-end anastomosis). One patient required superficialisation of the basilic vein and one patient transposition of the arterialised brachial vein. Maturation was achieved in six pAVF after a mean of 158 days with a mean fistula flow of 920 ml/ min. Conclusion We achieved high technical success and maturation rates in our first patients undergoing pAVF creation with the Ellipsys® system. Prerequisites are suitable anatomy of the cubital perforator vein and good skills in sonography and endovascular techniques. We believe that pAVF is a promising alternative to the creation of a conventional upper arm fistula in patients unsuitable for a distal radio-cephalic fistula.

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