A comparison of outcomes between open and endovascular arteriovenous access creation for hemodialysis

Preliminary outcomes for percutaneous endovascular autogenous access (endoAVF) have shown promising results; however, comparisons with surgical cohorts in dialysis populations are lacking. This study compares autogenous arteriovenous access created with the EverlinQ endoAVF system with accesses created by conventional surgical technique with respect to functional and patency related outcomes. This is a multicenter, retrospective review of autogenous arteriovenous accesses entered into a prospective database. Patients receiving radiocephalic, brachiocephalic, or endoAVF arteriovenous accesses between 2014 and 2019 were included. Autogenous access maturation, primary patency, secondary patency, steal syndrome, and reinterventions were collected and analyzed using standard statistical and survival analyses. A total of 369 accesses were created during the study period, including 61 endovascular accesses, 171 radiocephalic accesses, and 137 brachiocephalic accesses (median follow-up, 17 months; range, 1-71 months). Maturation failure at the end of follow-up was 27% ± 6%, 27% ± 5%, and 18% ± 4% for endovascular, radiocephalic, and brachiocephalic accesses, respectively (P = .049 for brachiocephalic vs endovascular accesses). Primary patencies at 12 and 24 months were 42% ± 5% and 32% ± 7% for endovascular accesses, 43% ± 4% and 24% ± 4% for radiocephalic accesses, and 42% ± 4% and 29% ± 4% for brachiocephalic accesses (P = .906). Secondary patencies at 12 and 24 months were 68% ± 6% and 60% ± 7% for endovascular accesses, 75% ± 3% and 67% ± 4% for radiocephalic accesses, and 91% ± 3% and 81% ± 4% for brachiocephalic accesses (P = .006 for brachiocephalic vs endovascular accesses). There were no statistically significant differences in ischemic steal syndrome (3.3%, 4.1%, and 8.0%; P = .229) or total reinterventions/year (1.0 ± 3.1, 0.9 ± 1.8, and 1.2 ± 1.8; P = .289) for endovascular, radiocephalic, or brachiocephalic arteriovenous accesses, respectively. EndoAVF compare favorably with respect to maturation and patency compared with surgically created accesses in a real-world cohort. Outcomes and reintervention rates are similar to conventional radiocephalic arteriovenous accesses, but are inferior with respect to patency and maturation to brachiocephalic accesses.