TITLE: Real-World Usage of the WavelinQ EndoAVF System
BACKGROUND: Dependent on existing deep to superficial perforating venous branches, the WavelinQ EndoAVF System is a novel technique used to create an arteriovenous fistula (AVF) between ulnar or radial veins and concomitant arteries for dialysis access. We sought to examine a single center's success rates and short-term follow-up using this device.
METHODS: All consecutive patients undergoing placement of a WavelinQ AVF from October 2018 to July 2019 were included. Preoperative/intraoperative variables including demographics, preoperative/postoperative duplex ultrasonography, success rate of procedure, and subsequent endovascular/surgical procedures were obtained. Descriptive statistics and comparison of groups requiring subsequent intervention were performed.
RESULTS: Thirty-five patients underwent placement of the WavelinQ AVF, with 32 (91%) patients having at least one documented follow-up. These patients were predominantly male (23/32, 72%) with an average age of 60.2 and 23 of 32 (72%) patients were on dialysis. Initial fistula creation success rate was 100%. Average procedural length was 120 min, fluoroscopy time 9.6 min, and contrast usage 52.2 mL. Eight of 32 (25%) patients had perioperative complications (3 hematomas, 3 contrast extravasations, 1 resolved vessel spasm all resolving spontaneously, and 1 pseudoaneurysm requiring surgical repair). Thirteen of 32 (41%) patients underwent subsequent endovascular interventions to assist with maturation [9/32 (28%) branch coiling, 5/32 (16%) angioplasty/stenting, and 3/32 (9%) access thrombectomy] and 4 of 32 (13%) patients required subsequent surgical interventions (1 pseudoaneurysm repair, 1 revision of fistula, and 2 definitive AVF creation in thrombosed grafts). The majority of accesses (30/32, 94%) were ulnar-ulnar fistulas and overall patency at average follow-up of 73 days was 88% (28/32) with average brachial artery inflow volume of 1,078 cc/min and average cephalic vein (18/32) outflow volume of 447 cc/min. Eleven of 23 (48%) patients on dialysis were successfully using the EndoAVF at follow-up.
CONCLUSIONS: The WavelinQ AVF system has a high initial procedural success rate, although a significant portion of patients require subsequent endovascular procedures to aid in maturation. Further work on determining factors predictive of need for reintervention is necessary.
SOURCE: Zemela MS, Minami HR, Alvarez AC, et al. Real-World Usage of the WavelinQ EndoAVF System[J]. Ann Vasc Surg, 2021, 70:116-122. DOI: 10.1016/j.avsg.2020.05.006.
背景：WavelinQ EndoAVF系统依赖于现有的深至浅穿静脉分支，是一种新技术，用于在尺静脉或桡静脉与伴行动脉之间制造动静脉内瘘(AVF)，作为透析通路。我们试图使用这种设备检查单个中心的成功率和短期随访。
方法：纳入2018年10月至2019年7月连续接受WavelinQ AVF置入术的所有患者。术前/术中变量包括人口统计学、术前/术后双功超声、手术成功率和随后的血管内/外科手术。对需要后续干预的组进行描述性统计和比较。
结果：35名患者接受了WavelinQ AVF的置入，32名患者(91%)至少有一次有记录的随访。这些患者以男性为主(23/32，72%)，平均年龄60.2岁，其中23例(72%)接受透析治疗。一期造瘘成功率为100%。平均手术时间120min，透视时间9.6min，造影剂用量52.2mL。32例患者中有8例(25%)出现围手术期并发症(血肿3例，造影剂外渗3例，可自行消退的血管痉挛1例，需手术修补的假性动脉瘤1例)。32名患者中有13名(41%)接受了随后的血管内干预以协助成熟[9/32(28%)分支缠绕，5/32(16%)血管成形术/支架，3/32(9%)入路血栓切除]，32名患者中有4名(13%)需要随后的手术治疗(1例假性动脉瘤修复，1例瘘管修补，2例移植物内明确血栓形成的的动静脉内瘘)。整体以尺-尺内瘘为主(30/32，94%)，平均随访73d，总通畅率为88%(28/32)，平均肱动脉流入流量为1078cc/min，平均头静脉(18/32)流出流量为447cc/min。23例透析患者中有11例(48%)在随访时成功使用了EndoAVF。
结论：WavelinQ AVF系统具有较高的初始手术成功率，尽管相当一部分患者需要随后的血管内手术来帮助其成熟。有必要进一步研究预测需要再干预的因素。
启发：该系统为内瘘搭建提供了一种新的方法。但从整体效果来看，该系统与传统内瘘手术相比，并未优势，还有待进一步改进。
