SGH leads pilot programme offering non-surgical procedure
to create dialysis access in arm
Singapore, 28 June 2022 — Soon, end-stage kidney failure patients may not have to go under the knife to create an access known as arteriovenous fistula (AVF) in their arm for haemodialysis.
Singapore General Hospital (SGH) will be leading a 3-year pilot programme, offering endovascular arteriovenous fistula (endoAVF) to 200 eligible patients from SGH, Changi General Hospital, Sengkang General Hospital, and National University Hospital, by the end of this year. The non-surgical day procedure requires just small needle punctures to connect an artery to a vein for the fistula. This comes after a small successful pilot in SGH in 2021.
Previously, about 80 per cent of patients with end-stage kidney failure choose to put off the creation of AVF. As a result of the delay, many had to be admitted for emergency dialysis via a catheter in their neck, groin, or chest. Prolonged use of the catheter however, increases patient’s risk of infection and death. The patient will still need to have a permanent AVF which typically takes an average of three months to mature after it is created before it could be used for dialysis. But not all AVF created will mature. About three in 10 patients may eventually have to explore other options such as an artificial graft.
The endoAVF may thus be an option for pre-dialysis patients who are hesitant or reluctant to undergo surgery because of the risks involved and stigma associated with fistula due to visible surgical scar. It also has a maturity rate of nine in 10 patients.
Narrowing of blood vessels in patients with AVF is common. In fact, 60 per cent of them visit hospitals, some more frequent than others, for a procedure known as angioplasty to open up their narrowed blood vessels. A reduced blood flow through the fistula affects the quality of dialysis. It also causes prolonged bleeding after puncture, or pain in the fistula.
Unlike AVF done surgically, overseas studies have shown that patients with endoAVF experienced fewer incidences of blood vessels narrowing or blockage. Patients with an existing AVF that fails repeatedly may still have an endoAVF created.
The Departments of Renal Medicine, Vascular Surgery, and Vascular and Interventional Radiology at SGH performs about 400 AVF creation as it is the recommended access for haemodialysis, and more than 1,000 angioplasties each year. The number is expected to increase as patients with end-stage kidney failure needing dialysis is rising by the year in Singapore.
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Carol Ang (Ms)