Division of Vascular and Endovascular Surgery, Department of Surgery, Saint Louis University, St. Louis, MO.
Division of Nephrology, Department of Internal Medicine, SSM St. Mary's Hospital, St. Louis, MO.
Ann Vasc Surg. 2021 Jan;70:116-122. doi: 10.1016/j.avsg.2020.05.006. Epub 2020 May 15.
Dependent on existing deep to superficial perforating venous branches, the WavelinQ EndoAVF System is a novel technique used to create an arteriovenous fistula (AVF) between ulnar or radial veins and concomitant arteries for dialysis access. We sought to examine a single center's success rates and short-term follow-up using this device.
All consecutive patients undergoing placement of a WavelinQ AVF from October 2018 to July 2019 were included. Preoperative/intraoperative variables including demographics, preoperative/postoperative duplex ultrasonography, success rate of procedure, and subsequent endovascular/surgical procedures were obtained. Descriptive statistics and comparison of groups requiring subsequent intervention were performed.
Thirty-five patients underwent placement of the WavelinQ AVF, with 32 (91%) patients having at least one documented follow-up. These patients were predominantly male (23/32, 72%) with an average age of 60.2 and 23 of 32 (72%) patients were on dialysis. Initial fistula creation success rate was 100%. Average procedural length was 120 min, fluoroscopy time 9.6 min, and contrast usage 52.2 mL. Eight of 32 (25%) patients had perioperative complications (3 hematomas, 3 contrast extravasations, 1 resolved vessel spasm all resolving spontaneously, and 1 pseudoaneurysm requiring surgical repair). Thirteen of 32 (41%) patients underwent subsequent endovascular interventions to assist with maturation [9/32 (28%) branch coiling, 5/32 (16%) angioplasty/stenting, and 3/32 (9%) access thrombectomy] and 4 of 32 (13%) patients required subsequent surgical interventions (1 pseudoaneurysm repair, 1 revision of fistula, and 2 definitive AVF creation in thrombosed grafts). The majority of accesses (30/32, 94%) were ulnar-ulnar fistulas and overall patency at average follow-up of 73 days was 88% (28/32) with average brachial artery inflow volume of 1,078 cc/min and average cephalic vein (18/32) outflow volume of 447 cc/min. Eleven of 23 (48%) patients on dialysis were successfully using the EndoAVF at follow-up.
The WavelinQ AVF system has a high initial procedural success rate, although a significant portion of patients require subsequent endovascular procedures to aid in maturation. Further work on determining factors predictive of need for reintervention is necessary.
依赖于现有的深至浅穿通静脉分支，WavelinQ 内瘘系统是一种用于在尺或桡静脉和伴行动脉之间创建动静脉瘘（AVF）的新技术，用于透析通路。我们旨在研究该设备在单一中心的成功率和短期随访情况。
纳入 2018 年 10 月至 2019 年 7 月期间使用 WavelinQ AVF 进行治疗的所有连续患者。获取术前/术中变量，包括人口统计学、术前/术后双功能超声检查、手术成功率以及随后的血管内/手术治疗情况。进行描述性统计和需要后续干预的组间比较。
35 例患者接受了 WavelinQ AVF 植入，其中 32 例（91%）患者至少有一次随访记录。这些患者主要为男性（23/32，72%），平均年龄为 60.2 岁，23 例（72%）患者正在接受透析治疗。初始瘘管创建成功率为 100%。平均手术时间为 120 分钟，透视时间为 9.6 分钟，造影剂用量为 52.2 毫升。32 例（25%）患者出现围手术期并发症（3 例血肿、3 例造影剂外渗、1 例血管痉挛自行缓解，1 例假性动脉瘤需要手术修复）。32 例（41%）患者随后接受了血管内介入治疗以辅助成熟[9/32（28%）分支线圈、5/32（16%）血管成形术/支架置入术和 3/32（9%）动静脉血栓切除术]，4 例（13%）患者需要进一步的手术干预（1 例假性动脉瘤修复术、1 例瘘管修正术和 2 例血栓形成移植中的确定性 AVF 建立）。大多数通路（30/32，94%）为尺尺瘘管，平均随访 73 天的总体通畅率为 88%（28/32），肱动脉流入量平均为 1078cc/min，头静脉（18/32）流出量平均为 447cc/min。23 例（48%）透析患者中有 11 例在随访时成功使用了内瘘。
WavelinQ AVF 系统初始手术成功率较高，但仍有相当一部分患者需要进一步的血管内治疗来辅助成熟。需要进一步研究确定需要再次干预的预测因素。
