Percutaneous endovascular forearm arteriovenous fistula creation for haemodialysis access

The condition

2.1 Chronic (long-term) haemodialysis is used to treat advanced chronic kidney disease in most people who have renal replacement therapy.

Current treatments

2.2 An arteriovenous fistula is considered the best type of vascular access for haemodialysis. It is usually created surgically by joining a vein and artery together in the forearm. An alternative is minimally invasive, percutaneous endovascular creation of an arteriovenous fistula.

The procedure

2.3 The procedure is usually done in an outpatient setting under local anaesthesia or conscious sedation. A tiny needle is used to puncture the skin in the proximal forearm. Using ultrasound and fluoroscopic guidance, 2 thin, flexible, specially designed catheters (one arterial and the other venous) are then advanced and positioned by guidewires in the chosen forearm vessels (the radial, ulnar or brachial artery and adjacent vein). The catheters are aligned close to each other (sometimes using inbuilt magnets). The arterial and venous walls are then fused side to side using heat and pressure, or a small burst of radiofrequency energy released from the catheters. This creates an arteriovenous fistula between the target vessels. The catheters are then removed. High-flow arterial blood passes through the vein and, with time, it arterialises. This allows needles to be inserted into the vein to provide vascular access during haemodialysis.

2.4 The exact technique may vary slightly depending on the device used.