we have a LVAD ESRD patient started witha catheter and a LUA AVF was created

and developed well.

Currently he has been using the AVF > 2 years withour significant complications.

he is anticoagulated for his LVAD>

No problems with blood flow or pressures.

This is a good question!

With the recent advancement in medicine, LVAD has been implanted in many patients, especially those with heart failure. There is also a strong association between heart failure and chronic kidney disease, which means there is a high possibility of placing an AVF in patients with LVAD.

With that being said, there is limited data reporting the success of AVF following LVAD placement. Theoretically, with the absence of pulsatile arterial flow in patients with LVAD, AVF maturation will be impaired. In turn, this will lead to higher failure rates of AVFs, increasing the catheter time and making it difficult to use every time.

Going back to your question, I have found this interesting case report describing a successful creation of AVF for HD in a patient with LVAD.

Title: Successful Hemodialysis Arteriovenous Fistula Creation in a Patient With Continuous-Flow Left Ventricular Assist Device Support - PubMed (nih.gov)

Link: https://pubmed.ncbi.nlm.nih.gov/27692441/

They introduced an idea that might be useful for your case:

"In our patient, an AVF was chosen over an AVG primarily due to his young age and stable hemodynamic and physical condition, which could portend better than usual longevity while receiving HD. His vessel mapping data also suggested reasonable vein diameter, with our general threshold of >3 mm as minimal acceptable size. An alternative plan was to initially place an AVG with conversion to a “secondary AVF” using the developed outflow vein if graft dysfunction arose. 12 This approach would minimize catheter time and possibly provide the longevity of an AVF if HD were continued long term".

I hope this was helpful.