Percutaneous Fistula Creation

The Ellipsys (Medtronic, Minneapolis, MN) percutaneous fistula is made at a single location in the proximal radial artery creating a tissue fused, sutureless anastomosis. Patient eligibility is limited by anatomic constraints of a suitable perforating vein (estimated to be found in as high as 66% of the dialysis population). The procedure is performed with ultrasound guidance with an average procedure time of 20 min. The initial anastomosis is small and requires 5 mm balloon dilation at the time of fistula creation or during a subsequent procedure to provide adequate flow for dialysis. The Ellipsys pAVF has an average brachial artery inflow of 1000 mL/min that supplies multiple outflow veins. Fistula flow is directed toward the cephalic and basilic veins to provide palpable access for cannulation. Experience thus far suggests that the Ellipsys pAVF can be performed with 95% technical success. Maturation rates exceed 85%, but secondary procedures are needed in in nearly all patients. A high percentage of patients achieve two needle cannulation at the prescribed rate, and once matured Ellipsys pAVF have low requirements for secondary procedures to maintain fistula function through 5 years of follow-up. Cannulation of pAVF requires additional training at the dialysis centers to access the multi-outflow system. Ellipsys pAVFs have shown to be been durable with 5 year functional patency of 92% and cumulative patency of 82%.