Percutaneous creation of arteriovenous fistulae (pAVF) is an alternative to a conventional upper arm cephalic or basilic vein fistula. Several studies have shown high technical success rates and comparable time of maturation. However, secondary interventions and surgical procedures are often necessary to achieve maturation.

Prospective data collection of the first consecutive patients undergoing the creation of pAVF between April and December 2021 at two vascular surgery centres with focus on secondary procedures.

PAVF creation with the Ellipsys® vascular access system was attempted in 18 patients (5 females, 13 men). We achieved technical success in 16 patients. In one patient with small and spastic vessels the needle could not be advanced into the proximal radial artery (PRA). One patient turned out to be anatomically unsuitable with a too large distance between the deep perforator vein (DPV) and the PRA. Conventional upper arm cephalic fistulas were created during the same procedure in both patients. In 7 patients, primary maturation of the cephalic or distal basilic vein was achieved. In one recently created pAVF, maturation still needs to be evaluated. Secondary procedures were necessary in 8/16 (50%) of pAVF created, 5 patients needed transposition or superficialisation procedures (3 basilic, 1 brachial and 1 cephalic vein). The superficialisation of a cephalic vein was carried out endoscopically. One patient required three additional procedures before the fistula could be used successfully (additional angioplasty of the fistula, superficialisation of the basilic vein and correction of a cubital vein stenosis by excision and end-to-end anastomosis). In one patient, a cubital communicating vein had to be ligated. One patient required an ultrasound-guided high-pressure balloon angioplasty of the anastomosis and DPV and another is scheduled for angioplasty. Maturation was achieved in 14 pAVF (88%) after a mean of 110 days with a mean fistula flow of 930 ml/ min.

To achieve maturation and functionality, half of our first patients undergoing pAVF creation with the Ellipsys® system required a secondary procedure. Angioplasties were less common than surgical intervention. We believe that pAVF is a promising alternative to the creation of a conventional upper arm fistula in patients unsuitable for a distal radio-cephalic fistula.