Real-time angio zonal diversion via acoustic navigation: A retrospective evaluation of 154 patients using a novel ligation technique to divert flow and maximize cannulation success in pAVF.

BACKGROUND

Percutaneous arteriovenous fistulas (pAVFs) are an important technological advancement in dialysis access but often suffer from incomplete maturation and poor cannulation due to split flow. The Real-time Angio Zonal Diversion via Acoustic Navigation (RAZDAN) technique is a minimally invasive, ultrasound-guided ligation method to redirect blood flow and improve cannulation outcomes.

METHODS

This retrospective, multicenter, multispecialty study evaluated 154 patients with immature Ellipsys pAVF using the RAZDAN technique between 2019 and 2024 to assist with maturation and subsequent cannulation. Outcomes included technical success, infection rate, and sustained occlusion at 6 months. Time intervals from access creation to maturation and catheter removal were analyzed.

RESULTS

Using the RAZDAN technique, 100% technical success was achieved without hospital-requiring complications. Mean time from access creation to maturation was 49.5 days, and to catheter removal was 95.5 days. Following ligation, maturation occurred at an average of 15.0 days, and catheter removal in 58.0 days. Infection occurred in 1.9% and nerve-related discomfort in 1.2%, all treated or resolved without hospitalization.

CONCLUSION

The RAZDAN technique offers a safe, effective, and reproducible option for enhancing cannulation in pAVFs. It provides a minimally invasive alternative for non-surgical specialists, potentially shortening catheter dependence and improving vascular access outcomes.