EndoAVF

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    Kidney disease is a condition affecting millions of people across the United States and the world at large. With the help of science and its progress over the decades, the condition is a manageable one, with various interventions, medications, and lifestyle interventions that make it possible for those affected to continue living full and productive lives.

    The introduction of is the EndoAVF is one of the latest developments in this field of medicine, which stands for the Endovascular Creation of an Arteriovenous Fistula. Here’s a simplified but thorough look at some of the key elements you might like to know when it comes to this procedure, including what to expect as a potential client of the vascular experts at PedesOC.

    EndoAVF: What it is and What Role it Plays

    The EndoAVF procedure is basically creating a suitable access point to a patient’s circulatory system that allows for the carrying out of the hemodialysis procedure. Gaining access to the vascular system is a key initial step in managing end-stage-renal-disease (ESRD), otherwise known as kidney failure. This is where the kidneys of a person’s body cannot keep up with the important role it plays in filtering out waste and toxins from the body, typically released in urine.

    The EndoAVF procedure

    ESRD patients experience a gradual accumulation of these unwanted substances in their bloodstreams, which might eventually see them enter toxic shock or eventual death. This is unless they are fortunate enough to receive a kidney transplant or undergo regular dialysis treatments. For many, the kidney transplant option might belong in the waiting, meaning dialysis treatment is a vital procedure for most renal patients.

    Now, hemodialysis (dialysis) is a procedure where the patient’s ‘dirty’ blood is mechanically filtered by being drawn out of their body, passed through a dialysis (filtration) machine, then reintroduced into their vascular system without toxins and waste it previously contained.

    The point to note here is that the entrance and exit point of the blood flowing into and out of the patient is referred to as the vascular access point. Creating this access point is the entire purpose of carrying out the EndoAVF procedure, and it is what vascular specialists are there for.

    What is Involved in this Procedure

    We mentioned the fact that the EndoAVF procedure is a relatively new innovation in this field, so you might be asking yourself – what came before it? The creation of an arteriovenous fistula (AVF) used to be conducted surgically. Surgeons would make incisions on the patient’s arm, manually reconfigure the vessels underneath so that an artery flows into an adjacent vein, and then close up the site. This complex procedure would often result in unsightly scarring, not to mention the high rates of failure reported.

    The functionality behind connecting an artery to a vein in the patient’s forearm causes the vein to become enlarged and its walls to thicken due to the increased pressure it experiences. After a few weeks to a month, it will have ‘matured,’ meaning it is ready to handle the dialysis process that will take place along this mature section of the patient’s vascular system. This is the all-important vascular access point we keep mentioning.

    The innovation that is the EndoAVF procedure lies in the Endo- PART. It refers to the fact that non-surgical methods create the vascular access point suitable for the dialysis process. In the EndoAVF process, specialists will make use of a dual magnetic catheter system. These are basically two very slim implements inserted into one suitably selected artery and vein either through the upper arm or through the wrist.

    After being guided along their selected pathways through fluoroscopic imaging, they will be halted at the chosen location to create the fistula (the place where the artery will join up with the vein). Here, a radiofrequency burst of energy will be released, creating a channel or link opening between the two implements. The arteriovenous fistula will thus have been established non-surgically.

    It will then be a matter of simply withdrawing the implements through their tiny openings and leaving the access point to ‘mature’ and ready for dialysis treatment. It is estimated that 90% of people have suitable vascular configurations to have this procedure carried out successfully.

    Benefits of Choosing EndoAVF

    Success rates: Studies conducted across the United States, Canada, and Europe have found that EndoAVF procedures have much higher success rates than other AVF methods. One study produced 32 successful procedures out of 33 patients, translating to a 96.2% success rate, which is the norm in various studies.

    Success in this instance is measured in terms of how well the actual procedure went (technical success), how often a patient will need to see their doctor due to complications after the procedure (intervention rates), and how long the AVF will be viable for dialysis treatments after the procedure (patency). An unsuccessful procedure will involve a failure of the access point to mature or other complications at the fistula site.

    Benefits of Choosing EndoAVF

    This procedure is minimally invasive, not requiring anything more than a tiny needle-like puncture wound in your upper arm or wrist to successfully carry out. This means that the risks associated with surgical methods which rely highly on the surgeon’s skill among other factors are not encountered.

    EndoAVF procedures will make it possible for vascular specialists to make use of other possible access points down the road due to the minimally disruptive nature of the procedure. Surgical AVF options might even be made use of in the future should the situation call for such measures. Surgical AVF makes it technically difficult, if not impossible, to exercise these options.

    Compared to other access methods such as catheterization or arteriovenous grafting, EndoAVF is very cost-effective.

    This is a big factor for many people who would love to avoid scarring in such exposed areas of their bodies wherever possible. The sutures that one would have to contend with after undergoing surgical AVF procedures are not experienced here.

    endoavf fistular creation

    Before the procedure is carried out, you will be called in to have your medical history taken down and a physical examination carried out to assess your current health status in case there are relevant details to take note of with regard to the prospective procedure. An ultrasound of your arm will then be taken so that the vascular specialists will get a picture of how the vessels in your arm are set up or configured (everyone’s is unique!) so that our specialists may chart out the best course to take.

    Come the day of the procedure, you should have your means of transportation back home arranged in advance as your arm might be weakened, impairing your ability to drive normally. The procedure itself takes place in an operating room set up with specialized X-Ray and ultrasound equipment.

    You will be laid out on your back with your arm extended to one side, where it will be scrubbed and sterilized using antiseptic solutions to eliminate any possible contagions before being draped in preparation for the procedure.

    The specialist will then administer a nerve-blocking agent or local anesthetic to numb the area of the procedure, thereby minimizing any possible discomfort you might feel. At your inner elbow or upper arm, a thin implement (like a needle) will be inserted into two of the vessels (an artery and a vein) located there, with no more discomfort than you would experience while having blood drawn.

    Taking approximately 30 minutes, the procedure will be carried out in full with little to mild discomfort on your part. After the withdrawal of the implements, pressure will be applied to the entry points in order to stem any blood flow and a bandage placed over it.

    According to the American Heart Association reports, it is estimated that about 8.5 million Americans, most of them aged above 50 years, suffer from PAD. While doctors have not found the exact cause that leads to plaque buildup in the arteries, controlling various PAD risk factors can help in reducing the plaque deposits in the artery.

    • Smoking

    Smoking is one of the main contributors to the onset of peripheral artery disease. Smoking usually damages the arteries’ inner layers. As the body attempts to heal itself, plaque often builds upon the damaged area. The condition also leads to the formation of blood clots (thrombi). Thrombi tend to stick to the artery walls, narrowing the space for blood flow even further. According to the National Institutes of Health, ceasing to smoke is shown to be effective in reducing or eliminating the PAD effects.

    • Lack of Exercise

    Lack of exercise is another strong indicator that is connected to peripheral arterial disease. Patients suffering from PAD will benefit enormously by exercising regularly. Regular workouts improve blood flow and boost overall health by reducing blood sugar and blood pressure. It also helps lower cholesterol, which is the main constituent of plaque.

    • High Cholesterol, Diabetes & High Blood Pressure

    Patients who have diabetes are also at high risk of PAD due to high blood sugar. High blood glucose is connected to plaque buildup in the arteries. Medical practitioners state that controlling Type II diabetes through the proper diet, exercise, glucose monitoring, and medication helps in reducing PAD risks. Patients diagnosed with high blood pressure and high cholesterol are also at increased risks of PAD. Maintaining a healthy diet and exercise can help reduce blood pressure and cholesterol, which is key to reducing PAD risks.

    • Blood Vessel Inflammation

    PAD is not always linked to plaque buildup in the arteries. The condition may also develop due to blood vessel inflammation, which also causes the arteries to narrow. People with leg injuries may also be at high risk for PAD. The condition is also caused by radiation exposure and unusual ligaments and muscle anatomy.

    Other factors that increase the risks of developing artery disease include

    • Obesity, especially in people with a body mass index over 30
    • People suffering from heart disease. According to The American Heart Association reports, people with heart disease have a 1 in 3 chance of having PAD
    • Increasing age, especially people aged over 65 years. Individuals aged 50 years and have the risks factors for atherosclerosis have a higher chance of contracting PAD
    • Hereditary factors- if your family has a history of peripheral artery disease, stroke, or heart disease
    • People with high levels of Homocysteine. Homocysteine is an amino acid that helps the body to make protein and tissue building
    • Gender – males are at a higher risk than females

    It is also important to note that in Peripheral arterial disease, the risk factors are addictive. This means that if a person has a combination of two risk factors, such as smoking and high cholesterol, this individual is at an increased risk of having a more severe PAD than an individual with only one risk factor has.

    You will then be brought back out to the pre-procedure area where you will be in recovery for about an hour to an hour-and-a-half.

    And that’s it! You will be provided with written instructions on how to care for yourself and your arm after the procedure. This will usually involve instructions such as not to operate heavy machinery, avoid alcohol, keep the wound free of pressure, and such for at least 24 hours after the procedure, after which you will be free to get back to your normal routine.

    You might experience some mild pain, bruising, or swelling at the site of the puncture, but this shouldn’t worry you. What you should look out for, and let your doctor know about, is pus developing, worsening swelling or redness, or the lack of a pulse at or around the puncture site.

    What to Expect from Your Visit to Pedes

    ULTRASOUND

    ULTRASOUND

    Your treatment will begin with an ultrasound examination of your veins, arteries, or both, in your legs to diagnose the presence and extent of the disease. Your test results will be immediately available to review with the doctor.

    CONSULT

    CONSULT

    Once we review the results of your diagnostic tests, our physicians will help you develop a plan to provide you with the best treatment for your disease.

    TREATMENT

    TREATMENT

    Depending on the extent of disease in your arteries or veins, our specialists may recommend minimally invasive intervention and/or prescribe medications to help your symptoms.

    FOLLOW UP

    FOLLOW UP

    It is important to make sure that you return for every scheduled follow-up appointment to ensure that your disease is appropriately monitored. If you ever have any questions or concerns, please call or schedule a follow-up appointment with our staff.