Johnathan Ngo1, Imelda De Guzman1, Bryan Barry1, Jules Catt1, Jeffrey Wong1
1Liverpool Hospital, Liverpool, Australia
Biography:
Dr Johnathan Ngo is a recently fellowed Nephrologist and the current Transplant Fellow at Liverpool hospital. His special interests include general nephrology, renal transplantation, health informatics and data analytics. He is actively involved in the provision of medical education.
Aim:
To report our centre’s initial experience with endovascular arteriovenous fistula (Endo-AVF) creation.
Background:
Endo AVF creation is an emerging minimally invasive alternative to surgical AVF for haemodialysis access. Our centre has recently implemented this procedure.
Method:
We conducted a prospective observational study of all patients referred for endo-AVF evaluation between October 2024 and April 2025. Outcomes included suitability rates, creation rates, technical success, and cannulation success.
Results:
Of 39 patients referred, 36 (92 %) underwent mapping. Twenty-nine (81 %) were deemed suitable, and 13 Endo-AVFs were created in suitable patients (45%; 100 % technical success). The cohort was predominantly male (74%), with diabetes (49%) and ischaemic heart disease (23%). The preferred configuration was radial-radial (69%) and using the left arm (69%). Median referral-to-procedure interval was 44 days (40 58). Four (31 %) Endo-AVFs were successfully cannulated after a median of 80 days (IQR 73 86). One (8%) developed a pseudoaneurysm one week after creation and required subsequent ligation. Six (46%) underwent fistuloplasty to augment maturation, of which one (17%) underwent a second fistuloplasty. In multivariable analysis (age, weight, diabetic status), no variable independently predicted timely cannulation.
Conclusion:
This initial experience indicates Endo-AVF is a feasible and promising alternative to surgical AVF. Majority of referred patients were suitable, technical success rate is very high, and a third of patients achieved successful cannulation within three months. This promising data warrants validation in larger cohorts with longer follow-up.