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June 6, 2019

RMC is First in SC to Offer Revolutionary New Dialysis Access Procedure

The Regional Medical Center (RMC) is the first hospital in the state and one of only a handful in the country to offer patients with end-stage kidney disease a new, minimally invasive dialysis access procedure called a percutaneous arteriovenous (AV) fistula.

For the last 50 years, the most common type of dialysis access procedure for adult patients has been the AV fistula, which is created by making a surgical connection between an artery and vein in a patient’s arm. Over a period of several months, the blood flow from the artery increases the diameter, strength and flow rate of the vein, making it suitable for the frequent insertion of needles used in dialysis treatment. Surgically created AV fistulas take an average of 4 ½ months to heal and for the vein to become mature enough for dialysis.

The percutaneous AV fistula procedure now being offered by RMC’s world-renowned Dialysis Access Institute (DAI) uses an implantable device to create an AV fistula, eliminating the need for surgery and drastically reducing recovery time, as well as the amount of time it takes for veins to become ready for dialysis. In fact, RMC’s DAI is already seeing the time between fistula creation and cannulation (the insertion of needles used in dialysis treatment) reduced from 4 ½ months to as few as two months.

“We are very pleased with the outcomes we’ve been seeing,” said John Ross, MD, Director of RMC’s Dialysis Access Center. “It’s faster, more efficient and less-invasive than a surgical fistula, and we are proud to be one of the first in the nation to provide our patients with this significant quality of life improvement.”

In June 2018, the Food and Drug Administration (FDA) approved two catheter-based devices for creating AV fistulas through the skin percutaneously, both of which are in use at RMC’s DAI.

The Ellipsys Vascular Access System from Avenu Medical replaces a surgical incision with a needle puncture, uses ultrasound imaging instead of surgical dissection and replaces sutures with tissue fusion. The EverlinQ endoAVF System from TVA Medical, Inc., uses two thin magnetic catheters that are inserted into the ulnar artery and ulnar vein in the arm through a small puncture. The magnets in each catheter attract, pulling the vein and artery together while an electrode from the venous catheter delivers radiofrequency energy to connect the two. The procedure for implanting either of these ingenious devices is performed on an outpatient basis in the doctor’s office and the patient leaves with just a band aid.

The ease and convenience of this groundbreaking new option for dialysis access should improve the patient experience and improve the quality of care for patients with end-stage renal disease. Percutaneous creation of arteriovenous fistulas can also be completed by endovascular surgeons, which will greatly increase the number of patients who receive the procedure.

Today, with more than 2 million dialysis patients globally and the incidence of end-stage renal disease expected to increase substantially as risk factors such as diabetes and obesity reach epidemic proportions, the availability percutaneous AV fistulas represents a historic milestone in the advancement of dialysis access at just the right time.

RMC’s DAI is internationally renowned for the treatment of end-stage renal disease patients whose access to the bloodstream needs to be established or has been compromised.  Each year, its surgical team completes more than 3,700 dialysis access procedures, most of which are performed on an outpatient basis.