513 - Risk Factors for Pseudoaneurysm After Percutaneous AV Fistula Creation with 4 Fr WavelinQ: A Retrospective Study

Purpose: Percutaneous arteriovenous fistula (pAVF) creation is a minimally invasive alternative to surgical AVF for hemodialysis access. This study aimed to evaluate the incidence of pseudoaneurysm formation in pAVFs created with two devices (WavelinQ and Ellipsys) and to identify risk factors for pseudoaneurysm formation, with a focus on the WavelinQ cohort.

Materials and Methods: We conducted a retrospective review of 33 patients who underwent pAVF creation between July 2021 and August 2025. Among them, 24 patients received a 4Fr WavelinQ endovascular AVF and 9 patients received an Ellipsys percutaneous AVF. Patient demographics (age, sex, diabetes mellitus, hypertension, atherosclerosis) and vascular measurements (anastomosis artery diameter, anastomosis vein diameter, perforator vein diameter, and preoperative superficial draining vein diameter) were collected from medical records. The occurrence of pseudoaneurysm at the AV anastomosis was documented. Logistic regression analysis was performed in the WavelinQ group to identify independent predictors of pseudoaneurysm formation. A p-value < 0.05 was considered statistically significant.

Results: Pseudoaneurysm formation was observed in 4 of 24 WavelinQ cases (16.7%) and in 0 of 9 Ellipsys cases (0%). All pseudoaneurysms occurred at the anastomosis site and were limited to the WavelinQ device group. Logistic regression analysis in the WavelinQ subgroup revealed that a smaller anastomosis vein size was associated with an increased risk of pseudoaneurysm formation, showing a trend toward statistical significance (odds ratio [OR] = 2.44, 95% confidence interval: 0.90–6.63, p = 0.07).
No other assessed variables showed a significant association with pseudoaneurysm occurrence in the WavelinQ group (p > 0.05 for age, sex, diabetes, hypertension, atherosclerosis, anastomosis artery size, perforator vein size, and preoperative superficial vein size). The Ellipsys cohort experienced no pseudoaneurysm complications in our series.

Conclusion: While logistic regression analysis did not reach statistical significance, the findings suggest a potential trend toward increased pseudoaneurysm formation in patients with smaller anastomosis vein size. This trend warrants further investigation with a larger sample size to confirm its clinical relevance. Identifying specific anatomical factors associated with pseudoaneurysm formation may assist in optimizing patient selection and procedural planning in pAVF creation using the 4Fr WavelinQ system.