What is the WavelinQ endoAVF?
An endovascular arteriovenous fistula (endoAVF) is created from inside the vessel with a catheter, using radiofrequency energy to form a connection between an artery and a vein, without the larger incision in the arm that conventional surgery requires. In 2024, Cardiovascular and Interventional Radiology published the two-year follow-up results of the WavelinQ 4 French system from three centers.
reference : BD youtube channel
Publication details
How was the study done?
A total of 112 patients (40 women and 72 men, mean age 60, range 18–88) underwent WavelinQ endovascular fistula creation at three centers. The study used Kaplan-Meier methods to analyze 2-year cumulative access patency, functional patency (usable with two-needle cannulation for dialysis) and primary patency, and Cox models to identify factors affecting maturation.
Main results
| Measure | Result |
|---|---|
| Technical success (successful creation confirmed on angiography) | 97.3%（109/112） |
| Matured and usable for dialysis | 98 patients, 87% of all 112; 11 of the 109 technically successful cases did not mature |
| Time to maturation (median) | 95 days (interquartile range 51–231 days) |
| 12-month / 24-month cumulative patency* | 94.3% / 91.7% |
| 12-month / 24-month functional patency* (two-needle cannulation) | 95.7% / 92.7% |
| Reinterventions per patient per year | 0.73 (43 maturation-assisting procedures [BAM] and 101 patency-maintaining angioplasties [PTA]) |
| Complications | 1 complication: pseudoaneurysm at the arterial puncture site |
* Patency rates are calculated on the basis of the 98 matured fistulas, not all 112 (a fistula that never matured does not enter the denominator of these rates).
- Factors associated with maturation: male sex, and brachial vein coiling performed at the time of fistula creation.
- There were 34 censored events during follow-up (4 patients received a kidney transplant and 30 died).
Limitations of this study
- A retrospective experience from three centers, with no control group (no direct comparison with conventional surgical fistulas); the level of evidence is Level 3.
- Patency rates include only matured fistulas, so they should not be read directly as “90% of everyone is patent after the procedure.”
- This is the clinical experience of three centers; whether it applies to other institutions remains to be confirmed by more research.
Summary
This study shows that, in the clinical experience of these three centers, the technical success rate of endovascular fistulas and the two-year patency after maturation were quite good. However, not everyone’s vessels are suited to this approach; whether it is suitable and how many follow-up procedures are needed must still be assessed by a vascular surgeon.
This article is an introduction to the academic literature, compiled from the original abstract and public information. Study results represent statistics for a group of patients; they do not represent the treatment outcome of an individual patient and are not a guarantee of effectiveness. For actual assessment and treatment, please discuss with your care team.
Original publication and links
Klein E, et al. Cardiovasc Intervent Radiol. 2024 Aug;47(8):1045-1054.
DOI：10.1007/s00270-024-03754-5 ｜ PubMed：PMID 38839640
Free full text: PubMed Central PMC11303495
Frequently Asked Questions
Q: Does an endovascular fistula need surgery?
A: It is created from inside the vessel with a catheter, so the wound is smaller than in conventional surgery. It is still an invasive procedure and not entirely without risk; this study, for example, had one pseudoaneurysm at the puncture site.
Q: Will it definitely be usable once it is done?
A: Not necessarily. Among the 109 technically successful cases in this study, 11 (about 10%) did not mature, and the median time to maturation was about 95 days, during which additional assisting procedures may be needed.
Q: Is the roughly 90% patency in the study the result for all patients?
A: No. It is calculated on the 98 patients whose fistulas matured, and this premise should be kept in mind when reading it.
Further reading: related articles on this site
To learn more about related topics, see the articles we have previously compiled:
- Dialysis Access Without a Surgical Incision? Minimally Invasive Endovascular AV Fistula (EndoAVF)
- How to Predict the Success of an Arteriovenous Fistula (AVF)
- Ultrasound Examination of Dialysis Access: Why Regular Follow-up Matters
- Arteriovenous Fistulas & Grafts
- Access Stenosis: What Should You Do? Maintenance and Treatment Every Dialysis Patient Should Know
