The Dialysis Access Institute at the Regional Medical Center is the first hospital in the state and one of only a handful in the country to offer patients with end-stage kidney disease a new option for the creation of hemodialysis access.
The minimally invasive procedure -- Percutaneous Fistula Creation -- has the potential to replace open surgical access creation. For the last 50 years, the most common type of dialysis access procedure for adult patients has been the surgical creation of an arteriovenous fistula, which is constructed by making a surgical connection between an artery and vein in a patient’s arm. Over a period of several weeks, the blood flow from the artery increases the diameter, strength and flow rate of the vein, making it suitable for the frequent insertion of dialysis needles used during treatment.
The percutaneous AV fistula procedure now being offered by RMC’s world-renowned DAI uses a small caliber catheter instead of surgery to create the fistula, which drastically reduces recovery time.
“We are very pleased with the outcomes we’ve been seeing with this approach,” said John Ross, MD, director of RMC’s Dialysis Access Center. “It’s faster, more efficient and less invasive than a surgical fistula, and we are proud to be one of the first in the nation to provide our patients with this significant quality of life improvement.”
In June 2018, the Food and Drug Administration approved two catheter-based devices for creating AV fistulas through the skin percutaneously, both of which are in use at RMC’s DAI. The Ellipsys Vascular Access System from Avenu Medical replaces a surgical incision with a needle puncture, uses ultrasound imaging instead of surgical dissection and replaces sutures with tissue fusion. The EverlinQ endoAVF System from Bard-BD Medical uses two thin magnetic catheters that are positioned into the ulnar artery and ulnar vein in the arm through two small skin punctures. The magnets in each catheter attract, pulling the vein and artery together while an electrode from the venous catheter delivers radiofrequency energy to form the fistula.
The procedure for implanting either of these ingenious devices is performed on an outpatient basis at the DAI, and the patient leaves with just a band aid.
The ease and convenience of this groundbreaking new option for dialysis access should improve the patient experience and improve the quality of care for patients with end-stage renal disease. Percutaneous creation of AV fistulas can also be performed with interventional radiologists, interventional nephrologists and endovascular surgeons, which will greatly increase the number of patients who receive the procedure. Today, with more than 2 million dialysis patients globally and the incidence of end-stage renal disease expected to increase substantially as risk factors such as diabetes and obesity reach epidemic proportions, the availability of percutaneous AV fistulas represents a historic milestone in the advancement of dialysis access at just the right time.
RMC’s DAI is internationally renowned for the treatment of end-stage renal disease patients whose access to the bloodstream needs to be established or has been compromised. Each year, its surgical team completes more than 3,700 dialysis access procedures, most of which are performed on an outpatient basis.