Abstract: FR-PO467
Case Series of Real-World Use of Percutaneous Arteriovenous Fistulas in an Urban Predominantly Black US Hemodialysis Population
Session Information
- Dialysis: Vascular Access
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Yadla, Gautam, Emory University, Atlanta, Georgia, United States
- Niyyar, Vandana Dua, Emory University, Atlanta, Georgia, United States
- Keyes, Jonathan, Emory University, Atlanta, Georgia, United States
- Forrester, Nathaniel, Emory University, Atlanta, Georgia, United States
- Rawls, Forest, Emory University, Atlanta, Georgia, United States
- Broxton-Key, Rodella, Emory University, Atlanta, Georgia, United States
- Cobb, Jason, Emory University, Atlanta, Georgia, United States
Background
Arteriovenous fistula (AVF) is the preferred vascular access for end-stage kidney disease (ESKD), but most patients in the US start hemodialysis (HD) with a tunneled dialysis catheter. Percutaneous (pAVF) creation systems (Ellipsys and WavelinQ) allow for non-surgical creation of AVFs. Published pAVF studies so far report higher patency rates (85-96%), less interventions, less surgical complications, and greater patient satisfaction compared to surgically created AVF. The percentage of Black patients varies from 0-20.6% in the literature, which vastly differs from our clinical population. We report a case series of real-world outcomes of pAVF in our urban predominantly Black HD patient population.
Methods
Retrospective chart review from 2021-2023 of patients from Emory Dialysis of all patients who received percutaneous AVF.
Results
Eleven patients had pAVF created by four proceduralists using either the Ellipsys or WavelinQ devices. Majority of patients were male (72.7%) and of Black race (91%). Common co-morbidities included hypertension (100%), diabetes mellitus (63.6%), and cardiovascular disease (36.4%). Mean age was 53.6 years, and the mean body mass index (BMI) was 34.6. Dialysis vintage ranged from 0.5 to 9 years, with mean duration of 2.7 years. 91% of patient had a tunneled dialysis catheter before having a fistula. Of 11 patients, 6 (54.5%) had their pAVFs functioning adequately for HD, 4 (36.4%) did not, 1 had 3 angioplasties but her pAVF was not used. Irrespective of ultimate functional patency, all required multiple interventions, with 10 of 11 patients (91%) requiring 2 or more interventions.
Conclusion
Overall, this case series provides real-world data on the use of pAVFs in an urban predominantly Black US dialysis population. To our knowledge, our study has the largest percentage of Black patients in the study population published so far. Our results indicate that though pAVFs can be successfully created in this population, a majority of patients require multiple secondary procedures, and only 54.5% were able to achieve functional patency. Further research with larger sample sizes and longer follow-up is warranted to evaluate the long-term patency rates and complications associated with pAVFs.