Initial single-center experience with a new external support device for the creation of the forearm native arteriovenous fistula for hemodialysis

Objective: To assess and compare the maturation rate of the native radiocephalic arteriovenous fistula (RC-AVF) created with and without a nitinol external support (VasQ (TM) Laminate Medical Technologies Ltd, Tel Aviv, Israel). Methods: Data of all consecutive patients who underwent the creation of native RC-AVFs at our center between October 2018 and January 2020 was prospectively collected and retrospectively analyzed. Selected patients who had a suitable vein and a radial artery with triphasic flow at preoperative duplex ultrasound exam and were selected for the creation of a radiocephalic fistula were included. Exclusion criteria were: malignant tumors, acute renal failure, previous upper limb revascularization, and septic status. Patency and maturation, vein, and artery diameter and blood flow rate were assessed at the following intervals: post-operatively, 24 h post-operatively, 1 month, 3 months, and 6 months post-operatively. Results: Forty-nine patients (31 males, mean age 65.7 years old) were included. Patients who received VasQ (TM) devices were 25 (VasQ group), the other 24 formed the control group. All patients underwent radio-cephalic AVF placement (21 on the wrist, 20 on the forearm, 8 on the proximal forearm). There were no perioperative complications and fatalities. At 1, 3, and 6 months, primary patency rates were 96 +/- 4%, 96 +/- 4%, 91 +/- 6% (VasQ group) versus 87 +/- 7%, 87 +/- 7%, 80 +/- 9% (control group, P 0.17), secondary patency rates were 96 +/- 4%, 96 +/- 4%, 91 +/- 6% (VasQ group) versus 95 +/- 4%, 90 +/- 7%, 90 +/- 7% (control group, P 0.79). A significantly larger vein diameter increase postoperatively (P 0.009) and a greater maturation rate (96% vs 74%, p 0.044) were found in the VasQ group compared to the control group. Conclusions: The use of the VasQ (TM) device was associated with higher maturation rates and larger vein diameters postoperatively. The patency rates were slightly higher but not significantly. Further studies are needed to confirm these findings.