title: Percutaneous creation of an arteriovenous fistula for hemodialysis access.
abstract: OBJECTIVE
  Arteriovenous fistulae (AVFs) created by conventional surgical techniques are associated with suboptimal short- and long-term patency. This study investigated the feasibility of creating fistulae with a percutaneous system and evaluated the utility of percutaneous AVFs (pAVFs) in providing hemodialysis access.
  
  
  METHODS
  From August 2012 to September 2013, a percutaneous system was used to attempt pAVF creation between the proximal ulnar artery and a closely associated ulnar vein in 33 patients. Technical success, adverse events, and time to pAVF maturity were recorded, as was clinical effectiveness at 6 months.
  
  
  RESULTS
  A pAVF was successfully created in 32 of 33 patients (97%). Four patients died during the follow-up period from causes unrelated to the procedure; one patient was lost to follow-up. Of the remaining 27 patients, 24 were undergoing successful dialysis via their pAVF at 6 months. Two additional patients had usable access but did not initiate dialysis during the study. One spontaneous pAVF thrombosis occurred in a patient with preexisting central vein stenosis. Cumulative pAVF patency at 6 months was 96.2% (26 of 27; standard error, 3.8%). Mean time to pAVF maturation was 58 days (range, 37-168 d). There was one serious procedure-related adverse event and five minor procedure-related adverse events.
  
  
  CONCLUSIONS
  Although larger studies are required to validate efficacy in a wide range of patients, this study demonstrates hemodialysis access successfully created with an endovascular catheter-based system. Patency of pAVFs and time to maturation were superior to published results of surgical techniques.
authors: Division of Vascular and Interventional Radiology, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada.
authors: Dheeraj K
authors: DK
authors: Rajan
authors: Cardiovascular Services, Italian Hospital, Asuncion, Paraguay.
authors: Adrian
authors: A
authors: Ebner
authors: Vascular Access Centers, Texas Heart Institute, Baylor College of Medicine, 6770 Bertner Ave., MC 2-114, Houston, TX 77030.
authors: Sudhen B
authors: SB
authors: Desai
authors: Center for Technology and Innovation, Texas Heart Institute, Baylor College of Medicine, 6770 Bertner Ave., MC 2-114, Houston, TX 77030.
authors: Jesus M
authors: JM
authors: Rios
authors: Division of Cardiovascular Surgery, Texas Heart Institute, Baylor College of Medicine, 6770 Bertner Ave., MC 2-114, Houston, TX 77030.. Electronic address: wcohn@texasheart.org.
authors: William E
authors: WE
authors: Cohn
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D017535:Ulnar Artery / Q000601:surgery*; D014680:Veins / Q000601:surgery*