KOLs on Vascular Access Challenges in 2025

Leading EU and US vascular access specialists this month discussed critical developments in the field. Two topics of debate were the recent withdrawal of endoAVF devices and the need for the development protocols on high-flow fistula management.

Medtronic Withdraws Ellipsis EndoAVF Device

In a surprising development, Medtronic has withdrawn its Ellipsis endovascular arteriovenous fistula (endoAVF) device from the market. Despite positive clinical outcomes and strong patient preference due to cosmetic advantages and fewer complications, adoption challenges and cost barriers appear to have influenced this decision. Experts noted the device faced reimbursement hurdles in several markets despite commanding 85-90% of the global percutaneous fistula market. Despite the withdrawal, there is optimism about the future of endoAVFs with new technologies like the VENOS 2 study. The VENOS 2 study involves a new device that simplifies the procedure and shows early promise. Experts highlighted the need for a second-generation device to reduce the number of procedures required for fistula maturation.

High-Flow Fistulas Present Unaddressed Challenges

Experts interviewed identified high-flow fistulas as a significant yet under-recognised clinical challenge, particularly in post-transplant patients. With flows reaching two to three litres—effectively tripling cardiac output—these fistulas can cause considerable cardiovascular strain. Despite this, systematic follow-up and management algorithms remain lacking. Discussions emphasised the importance of monitoring and potentially intervening in high flow fistulas to prevent complications. Experts believed there is a need for more rigorous follow-up and research to develop strategies for managing high flow fistulas.

ENDS