Endovascular arteriovenous fistula creation (2025 – CME) – online course
Description
Authors: P. Kitrou & S.Spiliopoulos
Reviewers: C. Cantwell, D. Filippiadis, R. Iezzi, E. Kehagias, H. Moriarty, M. Szmygin, & R. Uberoi
This course corresponds to chapter 2.2.1.3.6 Haemodialysis vascular access in the European Curriculum and Syllabus for Interventional Radiology.
Abstract
An arteriovenous vascular access circuit is a prerequisite for end stage kidney disease (ESKD) patients to receive haemodialysis (HD). Until recently, these circuits were surgically created by anastomosing an artery with a vein either directly (arteriovenous fistula-AVF) or via a synthetic graft (arteriovenous graft-AVG). AVFs have better survival rates compared to AVGs, however, maturation (the ability for an AVF to be used for HD) is their Achilles’ heel with high failure rates. Additionally, AVF creation sites are not infinite in the body of an HD patient.
The endovascular AVF (endoAVF) is a new option for vascular access creation. There are two devices available, both FDA approved, and CE marked. One uses radiofrequency energy and the other thermal energy, both targeting the level of the proximal forearm. Devices create the anastomosis in the deep venous system and use the perforator vein at the level of the elbow to divert the blood flow to the superficial venous system where cannulation takes place.
EndoAVFs provide additional options to possible anastomosis sites and act complementarily to the surgical ones as, in most of the cases, do not affect future surgical AVF creation. The main limitation of the technology is the lack of robust evidence as the technology is new and more studies are needed to validate the initial promising results.
The course offers all the details on how to create an endoAVF with both technologies, tips, and tricks, discusses the eligibility criteria, the data available and the prerequisites for establishing an endoAVF service.
Learning objectives
- Define the anatomy needed for an endoAVF creation.
- Choose the patients that are eligible for endoAVF based on anatomical criteria.
- Evaluate a patient with ultrasound to map the vessels included in an endovascular AVF.
- Describe an endoAVF creation procedure with both devices.
- Assess maturation of an endoAVF.
- Define the secondary procedures needed.
- Recognize the possible complications.
Further information
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.1.3.6 Haemodialysis vascular access.
The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC). Please note that this course will be taken offline on May 26, 2030.
The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.
The enrolment period of this course is linked to the validity of the All-Access Pass.
Release date: May 2025
