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Percutaneous and Surgical Femoral Arterial-Venous Fistula in an Ovine Model
Carlos E. Donayre, MD1, George Kopchok, BS2, Brad Kellerman1, Gene Reu1.
1LA BioMed Research Institute at Harbor-UCLA, Torrance, CA, USA, 2LA BioMed Research Institute at Harbor / UCLA, Torrance, CA, USA.
Objective: Prospective comparison of a percutaneous versus an open femoral arteriovenous fistulas in an ovine model
Methods: Six femoral AV fistulas were created utilizing standard side-to-side anastomoses with loupe magnification (Group A) in an ovine model. Six femoral percutaneous AV fistulas were also created in an ovine model utilizing high-definition ultrasound imaging to cannulate the femoral vein, and to direct a specially designed crossing wire from the femoral vein to the adjacent femoral artery. A catheter designed to bring the femoral artery and vein close together was then introduced and computer-control heat was applied to create a thermal resistance seal designed to hold the artery and vein together, with a concentric aperture between the artery and vein, creating an arterial-venous fistula (Group B).
Results: Both groups were survived for 15 and 30 days with duplex ultrasound follow-up imaging of femoral artery and vein, dimension determination, assessment of vessel and fistula patency, proximal venous outflow, and histopathological evaluation of the excised specimens. See attached table. The variable data did not attain statistical significance.
Histopathologic data confirmed patency determined by ultrasound and exhibited comparable neointimal tissue response and maturation between both methods.
Conclusion: Creation of percutaneous arteriovenous fistulas was successful in a femoral ovine model and compared favorably with fistulas created utilizing open surgical techniques. In this model prone to intimal hyperplasia formation avoidance of suture and foreign body reaction and lack of disruption of the vascular bed at the anastomotic site may have implications with regards to patency and fistula maturation. Utilization in humans with end stage renal disease appears feasible.
Comparison pAV fistula vs Surgical AV fistula | Surgical
Fem AV Fistula
(n=6) | Percutaneous
Fem AV Fistula
(n=6) | | Arterial diameter | 4.0 mm | 3.4 mm | | Initial vein diameter | 3.4 mm | 3.3 mm | | Vein diameter at explant | 4.4 mm | 4.6 mm | | Initial fistula length | 10.0 mm | 4.7 mm | | Fistula length at explant | 6.3 mm | 5.1 mm | | Initial fistula flow | NA | 769 ml/min | | Fistula flow at explant | 866 ml/min | 505 ml/min | | Patency | 83% | 100% |
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