title: Venous Window Needle Guide for deep vessels and difficult arteriovenous fistula cannulation.
abstract: The Venous Window Needle Guide (VWING™) has recently been proposed for patients with difficult arteriovenous fistula (AVF) access for hemodialysis due to deep vessels or other cannulation-related problems. This totally subcutaneous titanium device is sutured onto the upper wall of the matured fistula and may facilitate cannulation by the button-hole technique. We describe our initial experience with nine implants in six patients with a cumulative follow-up of 83 months, and make some experience-based technical suggestions for implant and surveillance radiological imaging. The indication for implantation was deep vessel, previous failure of cannulation or unsuitable site for direct cannulation. No infectious complications were observed during follow-up and proper blood flow was constantly achieved. Some difficulties were occasionally encountered with regard to cannulation; nonetheless, patient satisfaction was not significantly affected. VWING seems to be an interesting option in some patients provided that surgical implantation is carefully carried out and preventive measures against infections are strictly observed.
authors.affiliation: Struttura Complessa a Direzione Universitaria di Nefrologia e Dialisi e Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Ospedale Giovanni Bosco e Università di Torino, Turin, Italy. gforneris62@gmail.com.
authors.forename: Giacomo
authors.identifier: http://orcid.org/0000-0003-2489-1250
authors.initials: G
authors.lastname: Forneris
authors.affiliation: Struttura Complessa di Chirurgia Vascolare, Ospedale Giovanni Bosco, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Trogolo
authors.affiliation: Struttura Complessa a Direzione Universitaria di Nefrologia e Dialisi e Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Ospedale Giovanni Bosco e Università di Torino, Turin, Italy.
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Cecere
authors.affiliation: Servizio di Radiologia Interventistica, Ospedale Giovanni Bosco, Turin, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Savio
authors.affiliation: Struttura Complessa a Direzione Universitaria di Nefrologia e Dialisi e Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Ospedale Giovanni Bosco e Università di Torino, Turin, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation*; D002404:Catheterization / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D004867:Equipment Design; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009339:Needles; D017060:Patient Satisfaction; D010690:Phlebography / Q000379:methods; D006435:Renal Dialysis; D014025:Titanium; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D014025:Titanium
keywords: Artero-venous fistula; Cannulation; Deep fistula; VWING; Venous Window Needle Guide