PErcutanEous artErIovEnous fIstula crEatIon wIth thE wavElInQ DEvIcE . a rEtrosPEctIvE single-center analysis of 30 patients

2 The Journal of Vascular Access 22(6) 1Interventional Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; 2Interventional Radiology, Manchester Royal Infirmary, Manchester, United Kingdom; 3Interventional Nephrology, Salford Hospital, Manchester, United Kingdom; 4Renal Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; 5Renal Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom Introduction: A UK multicentre, prospective, randomised controlled trial examining the efficacy of paclitaxel eluting (DCB) vs standard angioplasty balloons in native haemodialysis fistulas was conducted between 2016 18. The trial was terminated prematurely amid the paclitaxel mortality controversy reported in peripheral vascular disease application in late 2018. Preliminary results of the recruited cohort are presented. Materials and Methods: Patients with dysfunctional, stenotic native fistulas were randomised to receive either a Ranger DCB or a standard angioplasty balloon. No pre-dilatation was required but post-dilatation with a high-pressure balloon was permitted in cases of residual stenosis >30%. The primary objective was to determine target lesion and access circuit primary patency as per standard definitions. Primary end-point was a composite of one or more of the following: >50% re-stenosis of index lesion requiring intervention, re-intervention on index lesion due to clinical or paraclinical indication, fistula failure. Clinical follow up was to 12 months with fistulography at 12, 25 and 52 weeks. Adverse events were recorded. results: A total of 92 patients were recruited, 45 in the DCB arm and 47 in the standard arm. There was a total of 54 de novo and 38 recurrent stenoses, across 36 forearm and 56 above elbow fistulas (48 brachiocephalic). Overall, primary patency at 12 months was 51.1% and 46.8% in the DCB and standard balloon arms respectively (p=0.41). Mean time to event was 273 days and 249 days, respectively. In subset analysis of the brachiocephalic fistula group (24 in DCB arm, 24 in standard arm), primary patency at 12 months was 42% vs 29% (p=0.04) with mean time to event of 266 days and 193 days respectively. conclusion: Although this trial was terminated prematurely, the Ranger DCB appears to prolong time to fistula re-stenosis compared to standard balloons, with significance demonstrated in brachiocephalic fistulas. ID:22 best paper award certificate of merit Presentation form: Poster double guide wire technique (dgt): optimization of iuxta-anastomotic stenosis endoVascular trEatMEnt Nicola Pirozzi1, Jacopo Scrivano1, Roberto Pirozzi2 1Interventional Nephrology Unit, Nuova ITOR, Rome, Italy; 2Endovascular Unit, Nuova ITOR, Roma, Italy background: Treatment options for juxta-anastomotic stenosis (JAS) of radio-cephalic arteriovenous fistula (RCAVF) are surgical bypass or angioplasty. As to endovascular treatment data from literature show a higher rate of recurrence (0.5 procedure/AVF/year). We describe the refinement of endovascular “double guide technique” (DGT) as to TurmelRodrigues original description. Patient and Methods: A 65y patients underwent DGT for a low flow (Qb) RCAVF due to JAS. By means of retrograde access through the outflow vein by a 6F introducer, two guide wire were navigated: the first one into proximal radial artery (GW1), the other into the distal artery (GW2). The introducer was removed and repositioned over the GW2, the GW1 left aside. A noncompliant balloon 6x40mm were inserted, the distal mark pushed at the curve the GW1 drowned trans-anastomotically. Inflations at 30atm were performed. After a check for rupture, balloon, GW2 and the introducer were removed, the GW1 being left in place. The introducer was repositioned over the GW1 and a semi-compliant 4x40 mm balloon, pushed trans-anastomotically, inflated at 18 atm. The final angiographic control was performed, the GW1 and balloon being removed after check for rupture. The RACVF was used as to the usual dialysis schedule. The RCAVF Qb improved from 350ml/min to 1100 and 1300 ml/min at 1 and 12-month respectively postoperatively. Discussion: DGT is effective in treating JAS, it allow a complete effacement of the stenosis by the use of two different balloon tailored for the different target: effluent vein and anastomotic area. The navigation is eased into different zones before dilatation. GW1 allow for treatment of artery spasm and serve as a secure device in case of rupture. In a previous series of DGT we described a recurrence rate of 0.28 procedure/patients/year. conlusion: DGT allow for a minimally invasive and long-term proficient treatment of juxta-anastomotic stenosis of RCAVF. ID:29 Presentation form: Poster controlateral endoVascular recanalization of the left brachio-cephalic Vein in patient wIth uPPEr arM artErIovEnous fIstula for hemodialysis Alessia Pini1, Raffaella Mauro1, Gianluca Faggioli1, Maria Letizia Soverini2, Annalisa Zucchelli2, Cristina Rocchi1, Mauro Gargiulo1 1Vascular Surgery, Univeristy of Bologna, Bologna, Italy; 2Nephrology, Dialysis and Hypertension, University of Bologna, Bologna, Italy Due to the widespread central venous catheters use, central venous occlusive disease (CVOD) had become extremely common in hemodialysis patients. It is often asymptomatic and incidentally diagnosed during imaging investigations; however, after an ipsilateral vascular access placement, it can lead to significant symptoms and to an ineffective dialysis. The CVOD is conventionally managed with antegrade endovascular recanalization, including angioplasty and stent placement. However, the treatment of long stenosis or tight obstructions can be extremely complex and require alternative technical strategies. We report a challenging case of brachiocephalic vein obstruction, successfully recanalized and stented from a contralateral approach; different other options could have been considered in this case but this technical strategy led not only to an excellent perioperative results, but also made it possible to preserve the ipsilateral and contralateral venous bed for future vascular accesses. This technique may be useful in patients in whom the standard antegrade approach fail. ID:47 Presentation form: Oral aV fistula maturation delay pta knows the way Rui Filipe Nogueira, Nuno Afonso Oliveira, Emanuel Ferreira, Luís Rodrigues, Ana Belmira, Rui Alves Nephrology, Coimbra University Hospital Centre, Coimbra, Portugal background: Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest complication rate. Although we are still lacking consensus, surgery has