Richard Coursey, MD
Dr. Richard Coursey is a vascular and interventional radiologist in northern Colorado
January 19, 2021doctors, Fistula
A Physician’s Perspective: Richard Coursey, MD
We spoke with Dr. Rich Coursey about RIA Endovascular’s unique ability in offering the technology to create non-surgical, minimally invasive fistulas for patients who need or will need dialysis or plasmapheresis.
Why would someone want/need this service performed?
Hemodialysis was first performed on a Human in Germany in 1924. The first surgically created fistula for use with human hemodialysis was created in 1965. While surgical techniques in creating fistulas have improved since that time, the general way in which they are created has remained virtually unchanged for almost 60 years. A patient is put to sleep, has an incision made on their arm, and an artery and vein are sewn together to create the artery to vein short circuit or bypass (fistula). The fistula cannot be used right away because the veins take time to “mature” or enlarge in size. It takes approximately 3 months for the veins to “mature” or grow in size enough to allow for the hemodialysis nurse to access the veins successfully.
In 2019, a new way to create a hemodialysis fistula, called the WavelinQ (pronounced Wave-Link) procedure, became FDA approved. This new way of creating a fistula does not require the patient to be put to sleep, does not require an incision to be made, requires less recovery time, is generally ready to be used about 45 days after creation, and is overall cheaper to create.
Describe the procedure for us.
The WavelinQ procedure, a way to create a hemodialysis fistula without anesthesia or an incision, is done under X-ray guidance. Patients undergoing this procedure are given mild sedation, and a nerve in the arm is temporarily blocked by using a small amount of a numbing medication. A very small catheter or tube is inserted into an artery, and a second is inserted into a vein. These catheters have specially shaped magnets on them. When these magnetic catheters are advanced under X-ray to the right spot, the magnets “kiss,” bringing the artery wall and the vein wall very close together. A small, 0.7 second zap of radiofrequency energy is sent across the catheters and this creates a tiny hole between the artery and the vein. This tiny hole is the fistula. The catheters are then removed and small bandages are placed over the areas they were inserted into the skin.
The patient goes home the same day. This procedure normally takes approximately 1 hour to complete.
What value do you or your patients find in performing this procedure?
I have found that many patients who get news that their kidneys are not working very well dread the word “dialysis.” On top of that, it’s even a harder pill to swallow when a patient with failing kidneys is also told that in addition to having their lifestyle changed because of dialysis, they’ll also first need to have a surgery on their arm to create a fistula so they can have their dialysis. I’ve often seen people deny that they’ll ever require dialysis and also deny any potential need for a surgery. They put off having the fistula surgery until it is too late. Kidney function may worsen without much warning sometimes, and then there is not time to have the fistula surgery and for the veins to grow in size quickly enough to be used. These patients then must have a large IV placed in a neck vein, and it is through this large IV that their dialysis is performed. The IV catheter cannot be removed until after they have the fistula surgery and their veins grow large enough in size to be used. IV catheters used for dialysis can cause vein scars over time and can get infected. They also sometimes have to be worked on to keep them working well enough. Generally the least amount of time a catheter is in a vein is best.
With the WavelinQ fistula it doesn’t have to be this way. Because this is a minimally invasive procedure and not an open surgery, and because there is very limited recovery time required after the procedure, patient anxiety around having a fistula created should drastically decrease.
I tell patients it’s only two small needle pokes, about an hour of their time on the procedure table, and then they can be set in the future if they eventually do require or do decide to have dialysis after all. In many ways, it’s a pretty easy “insurance policy” they can keep in their back pocket to be ready one day, if that day ever comes, that they do need to have dialysis.
WavelinQ fistulas also generally do not result in the large vein lumps seen on the arms of some people that have had surgical fistulas. In fact, most people will not even know you have had a fistula placed! It is our hope that by making the process to create a fistula easier on patients, they will be more likely to have one created sooner than they may now. This hopefully will decrease or even eliminate how many patients ever have to have dialysis though IVs. This means less infection, less vein scar formation, and is a cheaper and more efficient way to care for kidney patients. I am very excited to be able to offer this revolutionary treatment option to kidney disease patients who live in and around Colorado.
– Dr. Richard Coursey, Jr.
(photo from the Wavelinq site where you can learn more about the product – https://wavelinq.bd.com/how-it-works/)