Early results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System Alexandros Mallios, MD, William C. Jennings, MD,

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Presentation transcript:

Early results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System Alexandros Mallios, MD, William C. Jennings, MD, Benoit Boura, MD, Alessandro Costanzo, MD, Pierre Bourquelot, MD, Myriam Combes, MD, MBA Journal of Vascular Surgery Volume 68, Issue 4, Pages 1150-1156 (October 2018) DOI: 10.1016/j.jvs.2018.01.036 Copyright © 2018 The Authors Terms and Conditions

Fig 1 Puncture of the proximal radial artery (PRA) through the deep communicating vein (DCV) at the level of the antecubital fossa. A guidewire is placed to secure the connection between artery and vein for the following steps of the procedure. Journal of Vascular Surgery 2018 68, 1150-1156DOI: (10.1016/j.jvs.2018.01.036) Copyright © 2018 The Authors Terms and Conditions

Fig 2 A, The Ellipsys catheter is advanced into the artery in an “open” position with the tip of the device in the artery and the base of the device remaining in the vein. B, Gentle traction is applied to the device to make sure that the device has captured the arterial wall—the operator can feel the resistance while the artery is seen secured adjacent to the vein. Journal of Vascular Surgery 2018 68, 1150-1156DOI: (10.1016/j.jvs.2018.01.036) Copyright © 2018 The Authors Terms and Conditions

Fig 3 The device is closed and activated. Thermal energy and pressure will cut and fuse the anastomosis between the proximal radial artery (PRA) and the deep communicating vein (DCV). Journal of Vascular Surgery 2018 68, 1150-1156DOI: (10.1016/j.jvs.2018.01.036) Copyright © 2018 The Authors Terms and Conditions

Fig 4 The anastomosis between the proximal radial artery (PRA) and the deep communicating vein (DCV) is completed. Journal of Vascular Surgery 2018 68, 1150-1156DOI: (10.1016/j.jvs.2018.01.036) Copyright © 2018 The Authors Terms and Conditions

Fig 5 Clinical photographs of patients. A, At 4 days after percutaneous arteriovenous fistula (pAVF) creation, no trace of the left arm pAVF site is visible. B, At 4 days after pAVF creation, the cephalic vein is already well developed. This pAVF was used with two needles 1 week after creation. C, The image shows a patient in whom both cephalic and basilic veins can be used for cannulation of the Y-shaped pAVF, taking advantage of both veins, offering more length and lower outflow pressures. D, The first patient of the series with two-needle cannulations “en Y,” having dialysis 1 month after creation. Journal of Vascular Surgery 2018 68, 1150-1156DOI: (10.1016/j.jvs.2018.01.036) Copyright © 2018 The Authors Terms and Conditions