Asking the Right Question

  • 1 Pascale Lane, MD, FASN, is affiliated with the University of Oklahoma Health Sciences Center, and is a member of the KN Editorial Advisory Board.
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What in your field hasn’t changed? What could be improved? What could be made less invasive? The impetus to improve on the way we currently do things will be a driving force in 2018.

This series of questions several years ago led to the Ellipsys® system for percutaneous placement of proximal radial arteriovenous fistulas for dialysis access. The system requires 2 mm arteries and veins. With the patient under sedation and local anesthesia, the device is placed through an antecubital venipuncture and threaded to the point where the vein lies adjacent to the proximal radial artery. The device

What in your field hasn’t changed? What could be improved? What could be made less invasive? The impetus to improve on the way we currently do things will be a driving force in 2018.

This series of questions several years ago led to the Ellipsys® system for percutaneous placement of proximal radial arteriovenous fistulas for dialysis access. The system requires 2 mm arteries and veins. With the patient under sedation and local anesthesia, the device is placed through an antecubital venipuncture and threaded to the point where the vein lies adjacent to the proximal radial artery. The device is then activated, using nanotechnology to fuse the vessel wall tissues, creating an anastomosis. Day 1 bloodflow of 334 mL/minute was achieved. The entire procedure takes 23 minutes, and no adverse events were reported.

The primary endpoint was 2 needle hemodialysis within 100 days, and 86% met this goal. Patency at 12 months was 87%. These values are similar to those seen with surgical fistulae. About half of patients required an additional procedure to open up the vein or raise the vessel to facilitate access, particularly in heavier patients.

The device is currently available in Europe and under review by the FDA.

Imagine getting a fistula without an incision or a surgeon! Now, what other procedures and processes can we improve?

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