Singapore's experience on the VasQ™ anastomotic external support device to augment arteriovenous fistula maturation: Real world outcomes.

Introduction: The VasQ™ anastomotic external support device is designed to facilitate maturation and usability of AVFs. This study reports the initial experience of VasQ usage across two centers in Singapore.

Methods: This is a review of 118 consecutive patients who had the VasQ™ device implanted during surgical AVF creation from October 2023 to February 2025 at two tertiary referral centers in Singapore.

Results: Out of the 118 AVFs created with the VasQ™ device, 57.6% were radiocephalic (RC) fistulas, 33.9% were brachiocephalic (BC) fistulas and 8.4% were brachiobasilic transposition (BVT) fistulas. The most common VasQ™ device size used in our population was size 4 (45.8%) followed by size 3 (29.7%). AVF physiological maturation was 64.4%, 83.1%, and 95.8% at 1, 3, and 6 months respectively. The overall balloon-assisted maturation (BAM) rate in our cohort of patients was 26.9%. There were 4 (3.9%) instances of hemodialysis access induced distal ischemia. There were no device related complications nor infections during the follow-up period. Primary patency was 62.5%, 49.0%, and 37.3% at 6, 12, and 18 months respectively. Secondary patency was 98.3%, 88.4%, and 86.2% at 6, 12, and 18 months respectively. Comparatively, previous retrospective series in our center demonstrated a primary failure rate of 25% with RC AVFs and primary patency rates of 33% and secondary patency rates of 72% at 12 months without the use of VasQ™ device.

Conclusion: The VasQ™ device demonstrated safety and efficacy with improved AVF maturation in a real-world Asian population, across all AVF types (RC, BC, and BVT). The rate of primary failure was low while the BAM rate has improved compared to our historical data. We recommend the use of VasQ™ device as standard of care in patients undergoing AVF creation.