Surgeons Using Minimally Invasive Approach at SMH to Simplify, Reduce Risks of Dialysis Treatment

Vascular surgeons at Sarasota Memorial recently became the first in southwest Florida to perform a breakthrough procedure designed to improve treatment, outcomes and quality of life for local dialysis patients.

Vascular surgeons Jason Wagner, MD, and Inkyong Parrack, MD, are using the new Ellipsys Vascular Access System to create arteriovenous fistulas – larger, more stable blood vessels created in the body for patients requiring ongoing dialysis treatment. The new approach transforms a complex surgery into a minimally invasive procedure that can be performed in the hospital’s outpatient Cape Surgery Center.

Arteriovenous fistulas have been created when vascular surgeons fuse an artery to a vein, creating a larger, more stable blood vessel that can be accessed for repeated dialysis treatments. Traditionally, surgeons created these fistulas by making an incision in the patient’s arm to access the vein and artery to be joined, and then would suture the vein and artery together into a fistula. 

The Ellipsys Vascular Access System flips that paradigm on its head. “I can do the same thing with just a needle poke,” says Dr. Wagner. “I send the patient home with a Band-Aid.”

Approved by the Food and Drug Administration in 2018, published research demonstrates the Ellipsys system outperforms surgically created fistulas in almost every respect—they mature faster, last longer and are much less invasive for patients. 

There are no incisions or stitches needed. Instead, surgeons using the Ellipsys system use a needle guided by ultrasound imaging to enter a vein in the forearm, pierce into the nearby artery, and deliver a mini catheter that fuses the artery and vein together with thermal energy. When the needle and catheter are removed, the opening between the artery and vein remains, creating a fistula. 

“This is really no different than placing a really big IV,” says Dr. Wagner. “We don’t have to destroy any anatomy to create a good fistula and the vein should not have any scarring on it.” No scarring means the fistula can be accessed again and again for dialysis treatment, without risk of the blood vessels collapsing. The procedure takes about 30 minutes or less, requires no general anesthesia, and results in less trauma, pain and infection risk than the surgical approach.

The greatest benefit, according to Dr. Wagner, comes in the ability to create fistulas in patients before they become a necessity, giving the fistula time to mature, so that it’s ready to use when dialysis begins.

“It has been scientifically and statistically proven that mortality is lower in patients who go on dialysis through a pre-existing fistula,” says Dr. Wagner. With the minimally invasive Ellipsys system, he said he hopes more patients will undergo the procedure in preparation for dialysis, instead of waiting and being forced to use a catheter while the fistula matures.