A novel single-needle distal return cannulation technique protects new arteriovenous fistulas and reduces reinterventions: A propensity score-matched cohort study

Abstract

Background:

The initial cannulation period is critical for the long-term patency of a newly created arteriovenous fistula (AVF). This study evaluated whether a novel single-needle distal return (SNDR) technique, applied from the start of AVF use, could reduce reinterventions and protect the fistula compared to conventional two-needle cannulation.

Methods:

In this retrospective cohort study, we included 95 patients with new AVFs. Thirty-three received SNDR cannulation, while 62 received conventional cannulation. Using propensity score matching (1:1) for age, comorbidities, and laboratory and AVF characteristics, 25 well-matched pairs were generated for analysis. Primary outcomes were 6- and 12-month reintervention rates and access-related costs. Secondary outcomes included PTA-free survival, complications, and patient-reported outcomes. All analyses were conducted on an intention-to-treat basis, with 12-month outcomes assessed regardless of actual SNDR duration.

Results:

Over 12 months, the SNDR group demonstrated substantially lower reintervention rates than the conventional group at both 6 months (4.0% vs 32.0%, p = 0.024) and 12 months (8.0% vs 60.0%, p < 0.001). The annualized reintervention rate was 90% lower (0.12 vs 1.24 events/patient-year, p < 0.001). Kaplan-Meier analysis revealed significantly superior 12-month PTA-free survival for the SNDR group (92% vs 40%, Log-rank p < 0.001). Consequently, annual access-related costs were 75% lower in the SNDR group (¥8300 vs ¥33,800, p < 0.001). The SNDR technique also significantly reduced hematoma formation (4.0% vs 24.0%, p = 0.04) and improved patient-reported pain and satisfaction scores.

Conclusions:

For new AVFs, the proactive SNDR cannulation strategy suggests it as a potentially promising protective and cost-effective approach, significantly extending PTA-free survival, reducing complications and healthcare costs, and improving the patient experience compared to conventional cannulation.