Thrombosis focus and dialysis discussion at first CX renal interventions session

Yesterday’s renal interventions afternoon session yielded a rich vein of education and audience participation on everything from stent positioning to interventional training. With speakers including Matthew Gibson (Reading, United Kingdom) and Robert Shahverdyan (Hamburg, Germany), its talks provided a wide snapshot of the renal space.

SHAHVERDYAN OPENED THE SESSION BY presenting on a new endovascular arteriovenous fistula (endoAVF) device, the Velocity system (Venova Medical). Setting out a few of the challenges in dialysis access, he said that endoAVFs can pose particular challenges—including the fact that “not all patients have appropriate anatomy” and, centrally, the risks of juxta-anastomotic stenoses, partial deep venous flow and associated cannulation difficulties. The Velocity system, Shahverdyan averred, is the only endoAVF system “that would replicate surgical AVF (sAVF) anatomy”, offering as it does an end-to-side connection from the proximal radial artery to the perforator vein “without losing any flow into the deep venous system”. Citing the first-in-human VENOS trial results on the technology, he said that early use of the system “demonstrates clear proof” of its ability to improve vascular access care.

One early presentation by Matthew Gibson (Reading, United Kingdom) set out “a real-world approach” to managing thrombosed haemodialysis access. Clotted access is usually preventable, Gibson said, and can be due to a “failure”. This failure could be the surgical or radiological formation technique, monitoring needling technique or homeostasis (dehydration/hypotension), Gibson added. He also established the particular problems raised by clotted access. Compared to a preventative fistulopasty, he said, a declotting procedure results in a worse patient experience, worse success and complications rates, and was more time- and resourceconsuming. It also potentially poses the need for temporary access if delayed or unsuccessful.

But, he asked, what should you do when presented with access thrombosis? First, he urged listeners to “act quickly and effectively” to remove a thrombus