By: Dr. Omar Davis
I am an interventional nephrologist who has dedicated my entire career toward improving outcomes in dialysis patients through better vascular access care. My dedicated center provides access placement and repair and maintenance of existing accesses.
I am very familiar with the challenges our patients face. They are typically over 65 and have other medical conditions such as diabetes or hypertension that caused their kidneys to fail. Unfortunately, in the Memphis area, COVID has impacted the patient's ability to obtain a permanent access such as an AV Fistula (the preferred access type). Hospitals remain a danger zone for COVID infections in vulnerable patients like those on dialysis and surgical schedules are often full.
The development of innovations in dialysis vascular care has made it possible for free standing centers like mine to place AV accesses. In my opinion, the approval of a device to create a fistula without surgery (percutaneously) has revolutionized access placement. I am able to place an Ellipsys or WavelinQ percutaneous fistula (pAVF) in my office. The total procedure takes less than 1 hour and the patient leaves often with just a band aid rather than large incisions and dressings. No open surgery, sutures, or stitches are required!
This innovation has enabled me, working alongside local dialysis centers, to reduce the central venous catheter rates in my region. These pAVF fistulas function identically to a surgically placed fistula with less impact to the patient and better outcomes.
Having said that, all permanent accesses need periodic repair and maintenance and ongoing surveillance to ensure they are working properly. While physical exam remains the gold standard of assessing vascular accesses, surveillance data can provide additional insight into trends that indicate potential complications such as the development of stenosis within the access. One option for surveillance is Vasc-Alert, a fully automated medical device that utilizes treatment data from the electronic medical record to derive trends in intra-access pressures. Using this data along with physical assessment and monitoring for clinical indications can allow dialysis staff the ability to more efficiently identify vascular accesses with potential complications and refer them to the access center for evaluation.
I am thrilled that I can place a fistula in my office-based lab, but it is vital that the patient and dialysis unit continues to monitor the access and let me know if any problems occur so we can correct them in a timely manner and prevent thrombosis or permanent loss of the access.
There are many new innovations in the dialysis vascular access world, but I believe it is the percutaneous fistula creation devices that have really revolutionized access placement and given our dialysis patients more options with less associated risk.