Attempts to optimise the current state of play in vascular access for dialysis patients—from deployment of drug-coated balloons (DCBs) to more novel vein dilation technologies—piqued the interest of Renal Interventions readers throughout 2021. An in-depth interview with pioneering vascular access surgeon Alexandros Mallios (Paris, France) and the ever-expanding topic of renal denervation also feature among our top stories from the past year.
1. VIDEO: Amplifi™ Vein Dilation System—a novel device under development designed to prepare veins for AVF creation
The Amplifi Vein Dilation System (Artio Medical) is an innovative device designed to dilate arm veins in preparation for arteriovenous fistula (AVF) surgery using rapid, non-pulsatile venous blood flow. Surendra Shenoy—a vascular surgeon with specialist interest in vascular access and transplantation at Washington University School of Medicine in St Louis, USA—describes the system as one of the most exciting concepts he has encountered in the field of vascular access.
This video is sponsored by Artio Medical. Device in development. Not available for sale.
A patient-level meta-analysis of randomised controlled trials (RCTs) showed that drug-coated balloons (DCBs) were “consistently favoured” over percutaneous transluminal angioplasty (PTA) to prolong target lesion primary patency and access circuit primary patency in the treatment of dysfunctional haemodialysis venous access.
Fist Assist Devices announced completion of the FACT trial, which evaluated the use of an intermittent pneumatic compression device, model FA-1, to promote vein dilation in patients with kidney disease. The trial’s results suggested the device could enable an increase in the creation of functional arteriovenous fistulas by enlarging superficial veins and demonstrated the device’s safety in this patient population.
Born and raised in the small lakeside city of Kastoria in northern Greece, Alexandros Mallios’ 15-year journey as a vascular surgeon has seen him complete a year of national service in the Greek military, travel to far-flung parts of the Caribbean and Central America to perform complex procedures, and work with a number of pioneering physicians in the field. Today, he is the director of the Vascular Access Center at Hôpital Paris Saint-Joseph in Paris, France and chief of vascular surgery at Centre Hospitalier de Chartres in Le Coudray, France. His achievements include pioneering and performing the first ever percutaneous arteriovenous fistula (pAVF) creation with the Ellipsys system (Medtronic) in Europe, and co-founding the Paris Vascular Insights (PVI) conference.
Discussions at the Charing Cross (CX) 2021 Digital Edition (19–22 April, online) indicated that high-flow arteriovenous fistulas (AVFs) remain one of the more divisive topics in the field of vascular access. This was most apparent in the outcome of a debate on whether reducing flow in asymptomatic high-flow fistula patients is necessary, with audience polling revealing an exact 50/50 split across CX attendees.
Following a successful proof-of-concept study, Gerard S Goh and Markus P Schlaich have embarked upon a first-in-human study to explore the safety and efficacy of combined renal and common hepatic artery denervation in patients with type 2 diabetes and hypertension. Here, the co-principal investigators describe the rationale behind their single-blinded, multicentre, prospective feasibility study—named the MODUS trial—and explore the “pandemic” of cardiometabolic disease.
7. VIDEO: Does anaesthetic technique during fistula creation influence long-term successful outcomes?
The largest randomised controlled trial comparing long-term surgical outcomes between two different anaesthetic techniques, the ACCESs study, recently launched in the UK to test whether regional, when compared to local, anaesthesia during arteriovenous fistula (AVF) creation will confer greater 12-month unassisted functional patency rates. Emma Aitken, chief investigator of the study and a consultant renal transplant surgeon at the Queen Elizabeth University Hospital in Glasgow, UK, discusses the significance of this trial with Renal Interventions.
8. Balloon angioplasty in critical time window central to endovascular success for the slow-to-mature AVF
Tackling the main culprit, stenosis in the arteriovenous anastomosis and outflow veins, with balloon angioplasty before it is “too late” can boost maturation rates in slow-to-mature arteriovenous fistulas (AVFs). Robert Jones, consultant interventional radiologist at the Queen Elizabeth Hospital Birmingham, UK, set out his endovascular treatment strategy of balloon-assisted maturation at the Vascular Access Society of the Americas 2021 Spring Virtual Conference (VASA; 21–22 May, online).
9. Nitric oxide, simulation and “living” grafts: Is the landscape of vascular access set for a shake-up?
The field of vascular access care for haemodialysis patients may look very different in just a few years’ time, with a host of new, innovative technologies currently being developed and tested to help tackle existing challenges relating to infection, the long-term patency of blood vessels, and complications arising from poor needle cannulation—as demonstrated during a session at the Vascular Access Society of the Americas 2021 Spring Virtual Conference (VASA; 21–22 May, online).
The Ellipsys vascular access system (Medtronic) can be used to easily and safely create durable percutaneous arteriovenous fistulas (pAVFs) for haemodialysis—with new, long-term data suggesting it offers an “excellent alternative” to AVF creation via surgical procedures in end-stage renal disease (ESRD) patients. That is according to Jeffrey Hull, an interventional radiologist and director of the Richmond Vascular Institute in Richmond, USA, who presented five-year results from the Ellipsys US pivotal trial at the American Society of Nephrology (ASN) Kidney Week (2–7 November 2021, virtual).