Procedures
For patients randomly assigned to undergo creation of a cAV anastomosis via placement of the ROX Coupler, the procedure is accomplished within a standard vascular catheterization laboratory setting under fluoroscopic guidance. Using a modified Seldinger technique, a short 4F introducer sheath is placed into the left or right common femoral artery. An 11F customized venous introducer is placed in the ipsilateral common femoral vein approximately 2 cm inferior to the level of the arterial sheath insertion site. Target placement of the anastomotic coupler is between the distal external iliac vein and artery above the level of the femoral head and ischial spine. The ROX Crosshair wire (ROX Medical, Inc.) is advanced through the arterial introducer to mark the target arterial crossing location. Thereafter, a pre-curved, 21-gauge retractable micropuncture crossing needle is advanced through the venous introducer to the level of the arterial crosshair wire. The needle is then advanced out of the sheath and through the adjacent venous and arterial walls. A straight floppy-tipped nitinol 0.018-in. crossing wire is advanced through the crossing needle and into the common iliac artery. Following removal of the crossing needle, the coupler delivery system is advanced over the 0.018-in. wire from vein to artery. The arterial coupler arms are deployed followed by the venous arms and the delivery catheter removed. Lastly, a 4-mm balloon catheter is advanced over the straight 0.018-in. guide wire, positioned within the coupler and the anastomosis dilated to a fixed diameter of 4 mm. Femoral artery and vein homeostasis is achieved post-procedure with simple manual compression of the arterial and venous puncture sites, followed by bed rest for 3 to 4 hours. Anticoagulation was determined on an individual basis by the interventionalist. Post-procedure care included wearing compression stockings for 2 weeks or longer, as deemed appropriate by the study physician.

11906_2018_816_MOESM1_ESM.mov (15.3 mb)
Video 1 Crossing from the external iliac vein into the external iliac artery via a curved needle and advancement of a 0.018-in. wire into the external iliac artery. (MOV 15705 kb)

11906_2018_816_MOESM2_ESM.mov (7.5 mb)
Video 2 Deployment of the arterial portion of the ROX coupler. (MOV 7708 kb)

11906_2018_816_MOESM3_ESM.mov (9.4 mb)
Video 3 Deployment of the venous portion of the ROX coupler. (MOV 9652 kb)

11906_2018_816_MOESM4_ESM.mov (3.9 mb)
Video 4 Balloon dilatation with a 4-mm balloon to establish flow. (MOV 4001 kb)

11906_2018_816_MOESM5_ESM.mov (1.7 mb)
Video 5 Final angiography demonstrating a fistulous connection between the external iliac artery and vein. (MOV 1698 kb)


https://link.springer.com/article/10.1007/s11906-018-0816-8