The aim of this study is to report our mid-term results of percutaneous arteriovenous fistula (pAVF) creation using the Ellipsys device and present technical recommendations and our algorithm of pAVF maintenance. A single center comprehensive database of all consecutive pre-dialysis and end-stage renal disease patients that had a pAVF creation with the Ellipsys® device was reviewed retrospectively. Study endpoints included technical success, maturation, functional patency and required

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... ons. Between May 2017 and July 2019, 234 patients (mean age 64, 148 males - 63%) had a pAVF created. Technical success was achieved in 232 individuals (99%) and average duration of the procedure was 15 minutes (7-35minutes). Average follow up was 252 days (range 83-696). One year, primary, primary assisted and secondary patency were 54%, 85% and 96%, respectively. Average pAVF flow was 923ml/min (range 425-1440). There were no significant adverse events related to the procedure. Only 3 patients (1%) required a later conversion of the pAVF anastomosis to a surgical fistula. Twenty-four (10%) patients required superficialization of deep outflow veins due to difficult cannulation. Average maturation time was 4 weeks (range 1-12 weeks). Fourteen patients (6%) had early (< 2 weeks after creation) cannulation of their pAVF. The Ellipsys® pAVF device allows for the rapid and safe creation of a reliable autogenous access. Rates of technical success, patency and maturation were excellent. For patients unsuited for a distal radio-cephalic arteriovenous fistula, it should be considered the next preferred access option.