Catheter-Based Device Eases Fistula Creation

An ultrasound (US) guided device helps patients with failing kidneys receive an arteriovenous fistula (AVF) for hemodialysis without surgery.

The Avenu Medical (San Juan Capistrano, CA, USA) Ellipsys Vascular Access System is an image-guided vascular device designed to create a percutaneous AVF for hemodialysis access in patients with end-stage renal disease (ESRD). The system enables physicians to percutaneously access the proximal radial artery in the forearm with an outer access cannula, guidewire, and vessel capture construct under high frequency US guidance, creating a connection of the vein to the artery via an intra-vascular approach.

Once in position, a select amount of low power thermal energy is used to score the walls of the blood vessels and fuse the tissues together, thus creating an in-vivo anastomosis without leaving any foreign material, including sutures, in the resulting AVF. The use of thermal energy allows the Ellipsys System to leave the vasculature around the AVF site undisturbed, lowering costs and eliminating the need to form a technically difficult surgical anastomosis. The Ellipsys System has received the European Community CE mark of approval.

“The ease and convenience of the procedure should improve the patient experience and improve the quality of care for patients with end-stage renal disease,” said Jeffrey Hull, MD, director of the Richmond Vascular Center (VA, USA). “Percutaneous creation of arteriovenous fistulas can also be completed by endovascular surgeons, which will greatly increase the number of patients who receive this procedure.”

An AVF is the most recommended access for kidney disease patients undergoing dialysis, created by connecting a patient's vein and artery to form a long-lasting site through which blood can be removed and returned. In patients who are unsuitable for an AVF, an AVG--a plastic conduit between an artery and a vein--may be used. Other patients prefer a central venous catheter (CVC) instead, for reasons that may include inadequate preparation for dialysis, avoidance of surgery, or fear of needles.

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