Evidence on the safety of percutaneous endovascular forearm arteriovenous fistula creation for haemodialysis access raises no major safety concerns. However, evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do percutaneous endovascular forearm arteriovenous fistula creation for haemodialysis should:
Inform the clinical governance leads in their healthcare organisation.
Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedures outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.
Regularly review data on outcomes and safety for this procedure.
Patient selection should be done by a multidisciplinary team including a vascular access surgeon, nephrologist and interventional radiologist.
Report any problems with a medical device using the Medicines and Healthcare products Regulatory Agency's Yellow Card Scheme.
NICE encourages further research, preferably randomised controlled trials, into percutaneous endovascular forearm arteriovenous fistula creation for haemodialysis access. This should report details of patient selection, particularly about vascular anatomy, technique used, need for training, patency of the fistula and its subsequent ease of use, and quality of life.