Arteriovenous fistula (AVF) via the wrist or elbow has typically been the preferred route for dialysis through surgery. 

In this video Dr Nicholas Inston (Queen Elizabeth Hospital, UK), clinical service lead in renal surgery, discusses the latest results from a study which examined the effects and benefits of endoAVF creation using the WavelinQ™ 4F device. This device is used in the cutting and coagulation of blood vessel tissue in the peripheral vasculature for the creation of an AVF used for haemodialysis and offers a minimally-invasive treatment alternative via the mid-forearm. 

Questions:

1. What was the study design?
2. What were your findings?
3. What does this mean for patients?
4. What were the results?

Interviewer: Ashlynne Merrifield
Videographer: Natascha Wienand

Transcript Below :

Question 1 : Can you tell us about the study ?

So the study was to look at the effect of endovascular fistula creation using the WavelinQ device. This was a multi-center study that's been in numerous countries across Europe and Canada which recruited 100 patients which is the largest of its type so far. Used by the 6-French and 4-French device but predominantly the 4-French device and the outcome measures were really those that we'd look at in a standard surgical fistula creation study. 

Question 2 : What were your findings?

So the key results were very interesting, it showed that the device was actually very good at creating fistulas. A very high technical success rate when we created fistulas with this device. Not only that but these fistulas actually matured up very well and the maturation rate of the fistulas was high and then again with fistula functional cannulation and functional maturity is the important factor and these actually had a much higher functional maturation than fistulas created surgically. 

Question 3 : What does this mean for patients?

In terms of how this moves forwards and what this puts into the patients, it's a new site for a fistula. Fistula's traditionally been done at the wrist and the elbow. This actually is in the mid-forearm and in the deep vessels of the mid-forearm, so it actually gives much more options so therefore patients don't have to have an operation. Also it provides flow through different vessels than standard in terms of fistula creation. So not only the cephalic vein, but the basilic vein are often matured up. We don't know the implications of this long term yet but what it might mean is that future options for fistula surgical options in the future for patients will actually be better and the vessels will be in a better position to be used for surgical fistulas if that's needed in the future as well. 

Question 4 : What were the results?

The technical success with this device was high, with over 95% of fistulas being created at the first attempt with this device. The functional maturation which of course is the important factor with any fistula and that's the ability to cannulate it was also very high. In addition to that there was also very few interventions required in these patients. Much less than we would expect.