Comparison of surgical versus percutaneously created arteriovenous hemodialysis fistulae.

Abstract

OBJECTIVE\nThe aim of this study is to compare the results between percutaneous arteriovenous fistulae (p-AVF) created with the Ellipsys® device and surgical arteriovenous fistulae (s-AVF).\n\n\nMETHODS\nA single center retrospective comparative study of the first 107 patients that had a p-AVF creation with the Ellipsys® system between May 2017 and May 2018 with an equal number of consecutive s-AVF patients that had an access created in our center during the same time period. Primary endpoints included maturation and patency rates. Secondary endpoints were reinterventions, risk of infection, steal syndrome and aneurysm formation.\n\n\nRESULTS\nDemographics, hypertension and diabetes were similar for both groups. The only difference between groups was that more p-AVF patients were already receiving hemodialysis (61% vs 47%; P <0.05). p-AVFs had superior maturation rates at 6 weeks (65% vs 50%; P=0.01). Primary patency rates were higher for s-AVF 12 months (86% vs 61%; P<0.01), however primary patency was comparable between the two groups at 24 months (52% vs 55%; P=0.48). There was no significant difference in secondary patency rates at 12 (90% vs 91%) or 24 months (88% vs 91). At 2 year follow up, the rate of percutaneous reinterventions was similar but s-AVFs required more frequent surgical revisions (36% vs 17%; P=0.01). Issues with wound healing and infections were more frequent for s-AVF (9% vs 0.9%; P <0.01).\n\n\nCONCLUSIONS\nFistulae created percutaneously with Ellipsys® have superior maturation rates and similar patency with s-AVFs created in an experienced high-volume vascular surgery practice. pAVFs had a lower risk for wound healing issues, infection and surgical revision. Larger, prospective randomized multicenter studies are needed in order to confirm these findings.