energy. No radiation or contrast is used, no incisions or sutures are required and no foreign bodies are left behind. For a patient, the benefits of this technology are clear. It transforms a complex surgery into a minimally inva- sive procedure that can be performed in as little as 30 minutes in an outpatient setting like an ASC. The patient leaves with just an adhesive bandage on the arm and unlike surgery, there is little to no recovery; most patients can resume normal activities within 24 hours. Surgical fistulas have a high vol-

ume of blood flow, which can result in a bumpy, disfigured appearance of the arm over time. In contrast, the moderate flow of the endoAVF, com- bined with a lack of surgical scars, leads to better cosmetic outcomes and fewer

complications for patients—

all of which contribute to an overall improvement in quality of life. There are significant clinical bene-

fits with this endoAVF technology, as well. Recent studies demonstrate that it is a safe and effective method for fis- tula creation. Long-term data, accord- ing to the study in the September 2019 Journal of Vascular Access, show that more than 90 percent of endovascular fistulas are still functional after two years, while less than 75 percent of sur- gically created fistulas last two years, despite multiple interventions, accord- ing to a study published in the April 2020 Journal of Vascular Surgery. In addition, multiple studies—including one published in the April 2020 Jour- nal of Vascular and Interventional Radiology—indicate that endovascu- lar fistulas mature faster than surgical fistulas. This faster maturation is sig- nificant, as it can reduce, or even elim- inate, the amount of time patients rely on riskier methods of vascular access for dialysis, such as CVCs.

NANI Pioneers EndoAVF Technology As an organization dedicated to improving the patient care expe- rience, one of our main goals has


always been to help make life eas- ier for our patients. This is especially true for hemodialysis patients, who already spend so much of their lives under the care of various physicians; any improvement in their quality of life can have a significant impact. As a result, we were very inter-

ested in a procedure that would enable us to quickly and easily create dialy- sis access that would last a long time without the need for surgery or numer- ous additional procedures. For patients that are not suitable for a wrist radio- cephalic AV fistula, the endoAVF is an alternative. Approximately, 60 per- cent of ESRD patients we screen are candidates for endoAVF in our prac- tice. Candidates for the procedure are identified by a simple vein-mapping

appointment in one of our offices. When endoAVF is an option, most patients are excited about this safe and effective procedure that allows them to avoid surgery.

In May 2020, Bhanushali per-

formed the first endoAVF procedure at our Willow Springs Surgery Cen- ter. To date, we have performed more than a dozen procedures with excel- lent outcomes. NANI has a total of six vascular access centers—three ASCs and three office-based laboratories— across Illinois and Indiana, and we eventually plan to offer the endoAVF procedure at all six centers. With an estimated annual total of 7,000 pro- cedures across all sites, we have the unique ability to bring the benefits of

ASC FOCUS MAY 2021 | 9

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