Authors' objectives: Background Chronic kidney disease (CKD) is often caused by hypertension or diabetes mellitus type 2. Patients with endstage CKD need renal replacement therapy: hemodialysis, peritoneal dialysis, or kidney transplantation. In Sweden, the prevalence for any stage of CKD is 6%, and 3,200 patients (0.03% of the Swedish population) have end-stage CKD treated with hemodialysis. Long-term vascular access options for hemodialysis are arteriovenous fistula (AVF) or graft, and tunnelled central dialysis catheter (TDC). TDC carries a substantial risk for serious complications. The first choice is therefore a surgical AVF, but only 25% of patients start hemodialysis with an AVF due to, e.g., late referrals, long waiting time and time to maturation, i.e. the time until the AVF has adequate blood flow, vessel diameter, and vessel wall thickness to allow cannulation for dialysis. The novel endovascular AVF technique includes brachial artery and vein puncture, catheters positioned in the proximal ulnar artery and vein which are pulled together, followed by vaporisation of the tissue between the catheters. Endovascular AVF has been suggested to enable shorter waiting times and might thus have the potential to make a temporary TDC, with its associated risks, unnecessary. Question at issue: Is percutaneous endovascular AVF creation more effective and safer compared with surgical AVF creation regarding patient survival, reinterventions, technical success, functional usability, patency, and health-related quality of life in adult patients with end-stage kidney disease in need of hemodialysis?

Authors' results and conclusions: The novel technique endovascular AVF creation is poorly studied and comparisons with surgical AVF are very few. It is uncertain whether there is any difference in the frequency of reinterventions, primary patency and time from operation to cannulation after endovascular compared with surgical arteriovenous fistula creation for hemodialysis in patients with end-stage kidney disease (GRADE ⊕). Complications are frequent after endovascular as well as surgical AVF.

Project Status: Completed

Year Published: 2021

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-395/native/2021_122%20HTA-rapport%20Effektivitet%20och%20s%c3%a4kerhet%20f%c3%b6r%20endovaskul%c3%a4rt%20j%c3%a4mf%c3%b6rt%20med%20kirurgiskt%20anlagd%20arterio-ven%c3%b6s%20fistel%20f%c3%b6r%20hemodialys.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se