Endovascular AV Fistula Creation (EndoAVF) – Frequently Asked Questions

An Endovascular AV Fistula (EndoAVF) is a minimally invasive procedure designed to create an arteriovenous fistula (AVF) for patients undergoing hemodialysis due to kidney failure. Unlike traditional open surgery, this technique uses a catheter-based approach to form a direct connection between an artery and a vein, avoiding large surgical incisions and allowing for a quicker recovery.

EndoAVF offers several advantages over conventional AV fistula surgery. Since it does not require large incisions or stitches, the procedure is less invasive, reduces scarring, and minimizes the risk of complications such as infection or Steal Syndrome. 

Additionally, recovery is typically faster, allowing patients to return to their daily routines more quickly. The procedure is also shorter than traditional AVF creation, making it a practical option for those needing dialysis access without the downtime associated with open surgery.

EndoAVF is an option for patients with end-stage kidney disease (ESKD) who require hemodialysis. It is particularly beneficial for those who prefer a less invasive alternative to traditional surgery. Before proceeding, a vascular specialist will assess the patient’s arterial and venous anatomy to determine if EndoAVF is a suitable option.

The procedure begins with vascular mapping, where an ultrasound is used to evaluate the patient’s blood vessels and determine the optimal site for fistula creation.

Once the best location is identified, the patient receives regional anesthesia to ensure comfort throughout the procedure. A small incision, typically in the wrist or elbow, allows for the insertion of a catheter into the vein. Under X-ray or ultrasound guidance, the vascular specialist carefully forms a connection between an artery and a vein, creating the fistula that will facilitate dialysis. Once completed, the catheter is removed, and the small incision is covered with a dressing. The entire procedure typically takes between 30-60 minutes.

The primary benefit of EndoAVF is its minimally invasive nature, which eliminates the need for major surgery. Patients generally experience a quicker recovery, less post-procedure discomfort, and a lower risk of infection compared to traditional AVF surgery. Additionally, preserving veins for future dialysis access is a significant advantage, ensuring long-term options remain available.

There are two primary systems used for EndoAVF creation:

• WavelinQ™ System: This method utilizes two thin, magnetic catheters—one placed in an artery and another in a vein. When aligned, radiofrequency energy is applied, creating the fistula.
• Ellipsys® System: Unlike WavelinQ™, Ellipsys® employs a single catheter, inserted into a vein near the elbow. It uses thermal energy to create the artery-vein connection without the need for additional arterial access.

The choice of device depends on the patient’s vascular anatomy, and the vascular specialist will recommend the most suitable option.

Most patients can return home the same day, experiencing only mild swelling or bruising, which typically subsides within a few days. The newly created fistula requires 6-8 weeks to mature before it can be used for dialysis. Regular follow-up visits help monitor the maturation process and ensure that the fistula is functioning properly.

While EndoAVF is generally safe, there are some risks, including blood clot formation, vein narrowing, or the fistula not maturing properly. If the fistula does not develop as expected, additional procedures (ballooning or open surgery) may be needed to optimize blood flow. Patients will be closely monitored after the procedure to manage these risks effectively.

If you are considering EndoAVF for dialysis access, Dr. Darryl Lim is experienced in performing this procedure using both the WavelinQ™ and Ellipsys® systems. He can evaluate your condition and recommend the most suitable approach. To book a consultation:

📍 Visit: Novena Vascular & Varicose Vein Centre. 38 Irrawaddy Rd, #08-48, Singapore 329563
📞 Call or drop a message on WhatsApp: (+65) 9727-0788
📧 Email: contact@drdarryllim.com
🌐 Website: https://drdarryllim.com