Restricted accessResearch articleFirst published online 2025
Side-to-side versus end-to-side anastomosis in distal radiocephalic arteriovenous fistula: A retrospective comparative study of maturation,patency and complications
This study compared side-to-side (STS) versus end-to-side (ETS) anastomosis in distal radiocephalic arteriovenous fistula (AVF) regarding maturation, patency and complications.
Methods:
This was a single-centre, retrospective analysis of patients who underwent distal radiocephalic AVF creation between April 2018 and June 2024. Primary and secondary patency, maturation, thrombosis and reintervention rates were evaluated.
Results:
No significant perioperative complications occurred among 151 STS and 122 ETS patients. Secondary patency rates were similar (STS 97% vs ETS 93%, p = 0.229). Primary patency was higher in the STS group (56% vs 43%, p = 0.025), though time to patency loss was comparable (p = 0.378). Maturation rates without intervention were 89% (STS) and 83% (ETS), with no statistically significant difference (p = 0.158). Fistula flow was higher with STS. AVF thrombosis was more frequent in ETS (10% vs 3%, p = 0.000), as was radial artery thrombosis (5% vs 0.7%, p = 0.032).
Conclusions:
Our findings suggest STS is a safe, effective alternative to ETS in appropriate clinical settings.
AscherEGadePHingoraniA, et alChanges in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations. J Vasc Surg2000; 31: 84–92.
2.
SantoroDBenedettoFMondelloP, et alVascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis2014; 7: 281–294.
3.
DhingraRKYoungEWHulbert-ShearonTE, et alType of vascular access and mortality in U.S. hemodialysis patients. Kidney Int2001; 60: 1443–1451.
4.
LokCEHuberTSLeeT, et alKDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis2020; 75: S1–S164.
5.
FluckRKumwendaM.Renal Association Clinical Practice Guideline on vascular access for haemodialysis. Nephron Clin Pract2011; 118 Suppl 1: c225–c240.
6.
QuencerKBAriciM.Arteriovenous fistulas and their characteristic sites of stenosis. AJR Am J Roentgenol2015; 205: 726–734.
7.
ShahverdyanRMeyerTMatoussevitchV.Patency and functionality of radiocephalic arteriovenous fistulas with an external support device (VasQ™): real-world single-center experience. J Vasc Access2021; 22: 166–172.
8.
PereraGBMuellerMPKubaskaSM, et alSuperiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Ann Vasc Surg2004; 18: 66–73.
9.
Al-JaishiAAOliverMJThomasSM, et alPatency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis2014; 63: 464–478.
10.
ShethRAFreedRTavriS, et alNonmaturing fistulae: epidemiology, possible interventions, and outcomes. Tech Vasc Interv Radiol2017; 20: 31–37.
RooijensPPGMTordoirJHMStijnenT, et alRadiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg2004; 28: 583–589.
13.
RaynerHCPisoniRLGillespieBW, et alDialysis Outcomes and Practice Patterns Study. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int2003; 63: 323–330.
14.
WedgwoodKRWigginsPAGuillouPJ. A prospective study of end-to-side vs. side-to-side arteriovenous fistulas for haemodialysis. Br J Surg1984; 71: 640–642.
15.
O’BanionLAVan BurenDDavisJW.Radiocephalic fistulas for hemodialysis: a comparison of techniques. Am Surg2015; 81: 341–344.
16.
ZhouYWuH.Comparison of end-to-side versus side-to-side anastomosis in upper limb arteriovenous fistula in hemodialysis patients: a systematic review and meta-analysis. Front Surg2022; 9: 1079291.
17.
KasimzadeFAdaF.Comparison of one-year patency rates of end-to-side and side-to-side anastomosis technique in proximal forearm region radial-cephalic fistulas. Vascular2021; 29: 784–789.
18.
MozaffarMFallahMLotfollahzadehS, et alComparison of efficacy of side to side versus end to side arteriovenous fistulae formation in chronic renal failure as a permanent hemodialysis access. Nephrourol Mon2013; 5: 827–830.
19.
AhsanZ-UWaheedAZaeemFA, et alArteriovenous fistulas constructed using side-to-side anastomosis with ligation and division of distal venous arm; a tertiary care hospital experience. J Vasc Access2010; 11: 26–30.
20.
ElKassabyMElsayedNMosaadA, et alEnd-to-side versus side-to-side anastomosis with distal vein ligation for arteriovenous fistula creation. Vascular2021; 29: 790–796.
21.
SchmidliJWidmerMKBasileC, et alEditor’s choice - vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg2018; 55: 757–818.
22.
YiiELeeLPolkinghorneK, et alOptimal flow volume measurements in forearm versus arm arteriovenous fistulas. Nephrology (Carlton)2023; 28: 175–180.
23.
YiiEYiiMKThwaitesS, et alReceiver operating characteristic curve analysis of arteriovenous dialysis access flow using ultrasound. ANZ J Surg2022; 92: 461–465.
24.
KoSHBandykDFHodgkiss-HarlowKD, et alEstimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation. J Vasc Surg2015; 61: 1521–1527.
25.
SidawyANGrayRBesarabA, et alRecommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg2002; 35: 603–610.
