What is a percutaneous AV fistula?

A percutaneous AV fistula (PAVF) is a connection between an artery and vein created using catheter-based techniques without surgical incisions. It provides the high blood flow needed for hemodialysis.

How is PAVF different from traditional fistula surgery?

Traditional fistula surgery requires an incision and the surgeon dissects and connects the blood vessels. PAVF is performed through a small puncture using specialized devices, resulting in less trauma and faster recovery.

How long does the PAVF procedure take?

The procedure typically takes about 30 to 45 minutes. Most patients recover briefly afterward and return home the same day.

How long does it take for the fistula to mature?

Fistula maturation usually takes 4-8 weeks. During this time, the vein enlarges and strengthens to accommodate dialysis needles. Our team monitors the fistula with ultrasound to track progress.

Is the procedure painful?

The procedure is performed under local anesthesia with sedation. Most patients experience minimal discomfort during and after the procedure.

What are the advantages of PAVF over surgical fistula?

Advantages include no incisions, less scarring, a faster recovery, a shorter procedure time, and fewer wound-related complications because no incision is made — with maturation and durability broadly comparable to surgical fistulas (not proven superior). Some percutaneous fistulas need an additional minimally invasive step to complete maturation. Other access sites are preserved for future use.

Can I have a PAVF if I have had a previous surgical fistula?

Yes, PAVF can often be performed even in patients who have had previous access attempts. Your anatomy will be evaluated to determine the best approach for your specific situation.

Is PAVF covered by insurance for dialysis patients?

Medicare covers percutaneous AV fistula creation for eligible patients (CPT 36836/36837, effective 2023). Commercial and Medicaid coverage varies, and several major payers still review endovascular fistula creation as investigational, so we verify your benefits and handle prior authorization before treatment.

What happens if the PAVF does not mature properly?

If the fistula does not mature adequately, additional minimally invasive procedures can often help. In some cases, a traditional surgical fistula or graft may be needed as an alternative.

How do I schedule a consultation for dialysis fistula creation?

Scheduling is simple. Our team will review your kidney function, medical history, and perform a vascular evaluation to determine if PAVF is the right option for you.

Kidney Care and Dialysis Access

Prepare for Dialysis with Minimally Invasive Fistula Creation

Patients from Lake Charles, LA are seen at our Port Arthur office. A non-surgical procedure to create dialysis access by connecting an artery and vein percutaneously, offering a shorter recovery with no surgical incision.

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Medically reviewed by Zagum Bhatti, M.D. — Board-Certified Interventional Radiologist

Last reviewed: July 4, 2026

Patients from Lake Charles, LA are seen at our office located at 3300 Jimmy Johnson Blvd, Suite #130, Port Arthur, TX 77642 — 55 miles away.

What Is Percutaneous Dialysis Fistula Creation?

Percutaneous AV fistula (PAVF) creation is a minimally invasive procedure that creates a connection between an artery and vein in the arm using specialized devices, without making surgical incisions. This connection creates a high-flow access site for hemodialysis. Unlike traditional surgical fistula creation, which requires an incision and dissection of blood vessels, the percutaneous approach uses image guidance and catheter-based tools to create the fistula from inside the blood vessels. This results in less tissue trauma, a faster recovery, and fewer wound-related complications because no surgical incision is made. In published studies, maturation and durability are broadly comparable to surgical fistulas — not proven superior — and some fistulas need an additional minimally invasive step to complete maturation.

Who It's For

Who Can Benefit from Percutaneous Dialysis Fistula Creation?

Patients with advanced kidney disease who need hemodialysis require reliable vascular access. Percutaneous fistula creation offers a less invasive alternative to traditional surgical fistula creation, with shorter recovery times and outcomes broadly comparable to surgical fistulas in published studies.

Patients with Advanced Kidney Disease

When kidney function declines to the point where dialysis is needed, creating reliable vascular access is essential. PAVF offers a minimally invasive way to prepare for dialysis.

Patients Who Want to Avoid Surgery

Unlike traditional surgical fistula creation, PAVF requires no incisions. The entire procedure is performed through a small puncture in the skin, leading to faster recovery and less scarring.

Patients with Failed Previous Access

For patients who have had previous dialysis access attempts that failed, PAVF offers a new option that preserves other access sites for future use.

Patients Who Need Timely Dialysis Access

Percutaneous fistula creation is a same-day outpatient procedure with no surgical incision, so recovery is quick. The fistula still needs several weeks to mature — and some fistulas need an additional minimally invasive step — so your care team confirms readiness with follow-up ultrasound before it is used.

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Common Symptoms

Percutaneous Dialysis Fistula Creation for Patients Needing Dialysis Access

When kidneys can no longer filter waste effectively, dialysis becomes necessary. Having reliable vascular access is critical for successful hemodialysis. PAVF offers a modern approach to creating this access with less trauma and faster recovery than traditional surgery.

Advanced kidney disease requiring dialysis

Need for hemodialysis access

Desire to avoid surgical incisions

Previous access site complications

Anatomy suitable for percutaneous approach

Preference for faster recovery

PAVF is performed using specialized catheter-based devices that create a connection between an artery and vein from inside the vessels. The procedure is guided by ultrasound and X-ray to ensure precise placement and optimal blood flow.

After the procedure, the fistula needs time to mature before it can be used for dialysis. Maturation typically takes 4-8 weeks, and our team monitors the fistula with ultrasound to ensure it is developing properly.

If you're experiencing any of these symptoms, schedule a consultation now →

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What to Expect

Safety, Recovery, and What to Expect

The procedure takes about 30–45 minutes under local anesthetic with light (conscious) sedation, and most patients go home the same day and resume normal activity within a day or two with arm precautions. The fistula then matures over several weeks — on average about two months to first cannulation in published series — and Dr. Bhatti confirms readiness with follow-up ultrasound before it is used for dialysis.

Where this procedure stands today

Percutaneous (endovascular) AV fistula creation uses FDA-cleared devices — the Ellipsys system (De Novo classification, 2018) and the WavelinQ system (2018) — to create a hemodialysis fistula through pinhole access instead of an open incision. It is used mainly in selected patients with suitable forearm vessel anatomy; in published studies its outcomes are broadly comparable to surgical fistulas, and long-term comparative data continue to mature.

Maturation and adjunctive steps

Some fistulas need an additional minimally invasive maturation step — for example balloon angioplasty or embolization of a competing vein — before they can be cannulated. A minority of fistulas fail to mature adequately and may require salvage or an alternative access.

Possible risks

Access-site bruising or, less commonly, bleeding, and arm swelling can occur. Uncommon risks include steal (reduced hand blood flow), thrombosis, or the need to convert to a different access. No procedure guarantees a durable, working fistula.

Who is not a candidate

Not everyone has suitable vessel anatomy for a percutaneous fistula; candidacy depends on vein mapping and is confirmed by Dr. Bhatti. It is a way to create access — not a cure for kidney disease — and is not a universal replacement for surgical fistula creation.

A Less Invasive Option

Why Consider Percutaneous Fistula Creation?

For selected patients with suitable forearm-vein anatomy, a percutaneous (endovascular) fistula can create dialysis access without an open incision. It is an option for selected patients — not a replacement for surgical fistula creation when surgery is the better choice.

No surgical incision — access is created through a pinhole

Same-day outpatient procedure under local anesthetic with light sedation

Fewer wound-related complications because there is no incision

Preserves other access sites for future use

Outcomes broadly comparable to surgical fistulas in published studies

Percutaneous vs. Surgical AV Fistula

	Percutaneous Fistula	Surgical Fistula
Skin incision	None — pinhole access	Yes — surgical incision
Anesthesia	Local + light sedation	Local, regional, or (less often) general
Procedure time	About 30–45 minutes	About 60–120 minutes
Hospital stay	Same-day discharge	Usually same-day
Typical time to first use	Several weeks (avg ~2 months in series); adjunctive maturation sometimes needed	About 6 weeks or longer; roughly 20–40% need assisted maturation
Wound-care burden	Minimal — no incision	Post-surgical wound care
Candidacy	Selected patients with suitable forearm vessel anatomy	Broader anatomic range
Outcomes vs. surgical	Broadly comparable in published studies (no significant difference in a 1,929-patient meta-analysis) — not proven superior	Long-established standard
U.S. regulatory status	FDA-cleared devices (De Novo / 510(k)), on-label	Established standard of care
Insurance	Varies — Medicare covers eligible patients (CPT 36836/36837); several commercial plans deny as investigational — verify	Generally covered

Figures above are drawn from separate published series unless a head-to-head study is cited and are not a controlled comparison. Dr. Zagum Bhatti reviews which approach fits your anatomy.

Your Consultation

Schedule Your Dialysis Access Consultation

Dr. Zagum Bhatti reviews your kidney function, vein mapping, and access history to build a personalized dialysis-access plan — whether you are approaching dialysis, catheter-dependent, or managing a failed fistula. During your consultation, Dr. Bhatti will:

Review your kidney function and dialysis timeline
Perform vein mapping and a vessel-suitability assessment (ultrasound)
Discuss whether a percutaneous or surgical fistula fits your anatomy
Confirm candidacy
Walk through maturation, recovery, and risks
Verify your insurance benefits and prior authorization

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Got Questions?
Frequently Asked Questions

About Your Physician

Zagum Bhatti, M.D.

Board-Certified Interventional Radiologist

Founder & Chief Medical Officer; Interventional Radiologist

Dr. Zagum Bhatti is a board-certified, dual-fellowship-trained interventional radiologist and a former Assistant Professor of Vascular & Interventional Radiology at the University of Texas Health Science Center at Houston (UTHealth). He has dedicated his career to minimally invasive, image-guided procedures that treat serious conditions without open surgery. As Founder and Chief Medical Officer of Seamless Medical Centers, he brings academic-level expertise — including published peer-reviewed research in vascular and interventional radiology — to a community practice in Southeast Texas, making advanced treatments for enlarged prostate, uterine fibroids, knee osteoarthritis, peripheral artery disease, and chronic pain available close to home.

Education & training

B.S., Biochemistry — University of Wisconsin–Milwaukee (2001–2004)
Doctor of Medicine (M.D.) — Medical College of Wisconsin (2004–2008)
Residency, Diagnostic Radiology — Michigan State University College of Human Medicine (2008–2012)
Fellowship, Neuroradiology — Medical College of Wisconsin (2013–2014)
Fellowship, Vascular & Interventional Radiology — Rush University Medical Center (Rush Medical College) (2014–2015)

Board certification & licensure

Board Certified in Interventional Radiology / Diagnostic Radiology, American Board of Radiology — actively maintained in the ABR Continuing Certification (MOC) program
Texas Medical License #Q3852
NPI 1053577890

Selected publications

Portal Venous Interventions: How to Recognize, Avoid, or Get Out of Trouble in Transjugular Intrahepatic Portosystemic Shunt (TIPS), Balloon Occlusion Sclerosis (BRTO), and Portal Vein Embolization (PVE). Techniques in Vascular and Interventional Radiology 2018;21(4):267-287.
Percutaneous Venous Interventions in the Pulmonary Vascular, Central and Peripheral Venous Systems: How to Recognize, Avoid and Treat Complications. Techniques in Vascular and Interventional Radiology 2018;21(4):228-241.
Spontaneous Chyluria Treated with Retrograde Embolization via Direct Thoracic Duct Access at the Left Neck. Journal of Vascular and Interventional Radiology 2019;30(5):772-774.
Management of Vascular Complications of Extra-corporeal Membrane Oxygenation (ECMO). Cardiovascular Diagnosis and Therapy 2018;8(3):372-377.

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Medical Sources

The clinical information on this page is supported by the following peer-reviewed studies and professional medical society guidance.

Lok CE, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1–S164. — ESKD Life-Plan / individualized access; AV fistula preferred for suitable candidates.
Percutaneous endovascular arteriovenous fistula: a systematic review and meta-analysis (2022). — 1,929 patients; endoAVF technical success 98%; no significant difference vs surgical on procedural success.
Klein E, et al. Multi-center 2-year patency of endoAVF (4Fr WavelinQ). Cardiovasc Intervent Radiol. 2024. — Technical (angiographic) success 97.3%.
WavelinQ global post-market investigation (NCT04626427). — Procedural success 96.7%; mean time to cannulation ~2.0 months.
ASDIN Advocacy Flash — Update on endoAVF Coverage (2024). — Documents Humana and most BCBS-region non-coverage policies for CPT 36836/36837.

Ready to learn more?

Schedule a consultation with Dr. Bhatti to discuss your treatment options and see if this procedure is right for you.

Most major plans accepted, including Medicare/Medicaid — we verify before your visit.