Practice resources
Building a pAVF program
Behind the scenes of the new SIR practice guidance document By Bart L. Dolmatch, MD, FSIR, and Andrew J. Gunn, MD, FSIR
IR’s Renal and Genitourinary Clinical Specialty Council has formed a workgroup, in collaboration with the SIR
Statements and Guidelines Division, to establish society-based consensus recommendations for the creation and maturation of percutaneous arteriovenous fistulas (pAVFs) for hemodialysis access.
This document, which is available online at
jvir.org, provides an overview of best practices for the development of a pAVF program, from patient selection to billing guidance.
IR Quarterly spoke with Bart L. Dolmatch, MD, FSIR, chair of the SIR Renal and Genitourinary Clinical Specialty Council, and Andrew J. Gunn, MD, FSIR, who wrote the document.
16 IRQ | FALL 2025
Why is it important to have a practice guidance document on pAVF creation? Bart L. Dolmatch, MD, FSIR: First, SIR members should recognize that the world of pAVF creation has had a seismic shift following the recent announcement that the Ellipsys device will no longer be supported and is not available for anyone who wants to start a program. This happened in the midst of the pAVF practice guidance document (PGD) creation. So, at this time, the only option available for creation of a pAVF is the WaveLinQ system.
Meanwhile, there’s innovation on the way (currently in clinical trials) that may introduce another system for creation of pAVFs. There’s also some talk that the Ellipsys device may return to the
market. With that said, there are IRs who have already developed successful pAVF practices that meet the needs of patients who require hemodialysis and have suitable anatomy for non-surgical AVF creation. Although the landscape of pAVF is shifting, we felt that a PGD would be helpful to summarize how successful percutaneous AVF programs have been developed and share this information with IRs who are early into the development of a pAVF program.
How was the pAVF PGD produced? Andrew J. Gunn, MD, FSIR: We tapped the expertise of IRs who have active pAVF program, as well as those who are experts on treating patients who require hemodialysis. Then, we divided the pAVF PGD into sections and assigned small writing groups to each of these sections. Once all of the sections were written, everyone from the groups participated in editing the work into the final comprehensive PGD.
The Guidance Statements were written using information within the PGD sections, and each of the Guidance Statements went through a Delphi process with at least 80% consensus.
Additionally, we asked Andre Uflacker, MD, a SIR member who is a very
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