Johnathan Ngo1, Imelda De Guzman1, Bryan Barry1, Jules Catt1, Jeffrey Wong1
1Liverpool Hospital, , 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:
Compare referral to procedure intervals and outcomes between endovascular arteriovenous fistula (Endo AVF) and surgical arteriovenous fistula (AVF) creations performed during the same period.
Background:
Surgical AVF creation has been the standard approach for haemodialysis access, with Endo-AVF emerging as a minimally invasive alternative.
Method:
We retrospectively analysed patients who underwent either Endo-AVF (n=13) or surgical AVF (n=36) creation between December 2024 and March 2025, comparing demographics, waiting times, technical success, and clinical outcomes.
Results:
The Endo-AVF cohort had more males (77% vs 47%) and diabetics (46% vs 31%) and less ischaemic heart disease (8% vs 25%) than the surgical AVF group. Median referral to procedure time was 44 days (IQR 40 58) for Endo AVF versus 113 days (IQR 71 155) for surgery. AVF creation within 60 days from referral occurred in 11 Endo-AVF procedures (85%) versus 4 surgical procedures (11%). Technical success was 100% for both approaches. Post-AVF creation bleeding occurred in no Endo-AVF procedures versus 2 surgical procedures (6%). Seven fistuloplasties to augment maturation were performed in the Endo-AVF group, of which 1 was a second procedure, versus 3 fistuloplasties in the surgical AVF group. Primary AVF failure occurred in 1 from the Endo-AVF group (8%), due to pseudoaneurysm formation, and 2 from the surgical AVF group (6%), one due to bleeding complications. By study end, 4 (31%) of Endo-AVFs were successfully cannulated with a median time of 80 days (IQR 73-86), with one (3%) surgical AVF cannulated after 107 days.
Conclusion:
Endo-AVF reduced access creation wait-time significantly. Both approaches demonstrated excellent technical success. Demographic differences suggest different referral patterns or selection bias between groups. Longer follow-up is needed to determine the optimal approach for various patient populations and better compare outcomes between the two approaches.