In recent years, new emerging technology has allowed the endovascular creation of dialysis fistulas in the proximal forearm without the need for open surgery. Two such systems currently exist, and evidence to date has demonstrated high rates of technical success in fistula creation, high rates of dialysis functionality, and low rates of re-intervention using both systems. Whilst early trial data has demonstrated lower rates of re-intervention to maintain patency compared to surgical fistulas, endovascular re-interventions are still required to maintain functionality. The endovascular fistula (endoAVF) typically exhibits a shared drainage pattern and is morphologically distinct from the surgical fistula and patterns of failure observed often differ to what has been traditionally encountered. A fresh approach and understanding is therefore required and here we share our observations and experience of endovascular re-intervention in endoAVF created with the Wavelinq system.
Group-sequential analysis may allow for early trial termination: illustration by an intra-observer repeatability study