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a safe and effective method for access closure with sheath diameters up to and including 16 french. OBJECTIVE 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. METHODS 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,