UK-first innovation could save lives of dialysis patients

Barts Health NHS Trust has performed a UK-first operation outside of trial setting that could reduce mortality and risks of infection in patients with dialysis. 

Interventional radiologists at The Royal London Hospital (London, UK) have carried out the new minimally invasive arteriovenous fistula (AVF) procedure, WavelinQ EndoAVF (BD Bard).

An endovascular AVF involves fusing a connection between the artery and adjacent vein within the forearm using direct heat which patients can use for dialysis. This procedure is an alternative to the more invasive traditional option of open surgery.

The novel EndoAVF procedure results in a closed circuit that provides adequate blood flow to the superficial veins for dialysis and blood can be withdrawn, cleaned through a dialysis machine, and returned to the body.

With the EndoAVF system—conducted by interventional radiologists Ounali Jaffer, Rashid Akhtar and Rajesh Sivaprakasam at The Royal London Hospital—two thin catheters are inserted into the artery and the vein through small needle punctures.

Magnets help to align the devices and a connection is made between the vein and artery in the forearm without the need for open surgery, which allows clinicians to access the blood stream and gives patients a reliable long-term dialysis AV fistula.

The dual magnetic catheter system is removed from the body once the connection is created and the arm heals without stitches with little or no scarring.

Ounali Jaffer, interventional radiologist at The Royal London Hospital, said:

“This new treatment really enhances our techniques in treating those patients with end stage kidney disease. Avoiding a CVC is imperative and now we have another procedure available to enable timely AVF creation.

“There are only a finite number of options available in creating an AVF, which is the lifeline for the patient. By extending these options, we can maximise the use of these vessels.

“The obvious added benefits are that the procedure is relatively quick and leaves no sign of a procedure, with no visible scar. These are early days, but the innovation is exciting and will hopefully benefit a number of our local population with end-stage kidney disease.”