Sage Journals: Discover world-class research

Abstract

Introduction

There is lack of compelling evidence about the best technique to carry out the anastomosis between the artery and the vein: end to side or side to side. This issue was addressed by very few randomized controlled studies. This topic has recently re-emerged with the advent of the endovascular fistula creation using the side-to-side technique.

Objectives: To compare the results of both surgical techniques for the creation of arteriovenous anastomosis.

Methods

This is a randomized controlled prospective study. All renal failure patients, 18 years and older, referred to our institution requiring creation of a new arm arteriovenous fistulas, including distal radio-cephalic, ulno-basilic, proximal brachio-cephalic or brachio-basilic configurations were included.

Results

Between February 2018 and October 2018, 378 patients underwent creation of permanent haemodialysis access. A total of 100 patients were randomized equally into the end-to-side and side-to-side groups. Follow-up for the study purpose continued until May 2019 (mean = 9 months, range 1–12). Patients’ age ranged from 19 to 68 years. Sevety-seven arteriovenous fistulas were created at the elbow (37 brachio-basilic and 40 brachio-cephalic). Radio-cephalic fistulae were 23, created at wrist and in the forearm. Primary technical success was 97%, and 35 (70%) and 17 (34%) cases achieved functionally maturation in the end-to-side and side-to-side groups, respectively (P = 0.0001). Primary and secondary patency rates at 12 months were 76% end to side versus 78% STS (P = 0.381) and 84% end to side versus 86% STS (P = 0.225), respectively.

Conclusion

End-to-side technique should be used in all instances of arteriovenous fistulas creation.

Keywords

End to side side to side AV fistula dialysis technique and procedures

Get full access to this article

View all access options for this article.

References

Daugirdas

JT.

KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis 2015; 66: 884–930.

Lomonte

and Basile

Preoperative assessment and planning of haemodialysis vascular access. Clin Kidney J 2015; 8: 278–281.

Galic

AKG

Tomic

Rebac

, et al. The advantages of end-to-side arteriovenous anastomosis over the other two types of arteriovenous anastomosis in dialysis patients. Coll Antropot 2008; 32: 109–114.

Moini

Rasouli

Williams

, et al. Comparison of side-to-side brachiocephalic arteriovenous fistula with ligation of the perforating vein with end-to-side brachiocephalic arteriovenous fistula. EJVES Extra 2009; 17: 7–10.

Mozaffar

MFM

Lotfollahzadeh

Reza

, et al. Comparison of efficacy of side to side versus end to side arteriovenous fistulae formation in chronic renal failure as a permanent hemodialysis access. Nephro Urol Mon 2013; 3: 827–830.

Khan

and Qadir

Comparative study of efficacy of end-to-side with side-to-side arteriovenous fistula in patients on hemodialysis. Pak J Med Health Sci 2015; 9: 235–238.

O'Banion

Van Buren

and Davis

JW.

Radiocephalic fistulas for hemodialysis: a comparison of techniques. Am Surg 2015; 81: 341–344.

KR, Wedgwood

A prospective study of end-to-side vs. side-to-side arteriovenous fistulas for haemodialysis. Br J Surg 1984; 71: 640–642.

Tan

and Atik

Side-to-side anastomosis without vessel clamp: a practical method for arterio-venous fistula. Eur J Gen Med 2010; 7: 348–349.

10.

Shahverdyan

Beathard

Mushtaq

, et al. Comparison of outcomes of percutaneous arteriovenous fistulae creation by Ellipsys and WavelinQ devices. J Vasc Int Radiol 2020; 31: 1365–1372.

11.

Beathard

Litchfield

and Jennings

WC.

Two-year cumulative patency of endovascular arteriovenous fistula. J Vasc Access 2020; 21: 350–356.

12.

Schmidli

Widmer

Basile

, et al. Editor’s choice – vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 757–818.

13.

Sahasrabudhe

Dighe

Panse

, et al. Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis. Ind J Nephrol 2013; 23: 191–195.

14.

Ganiei

HLFA

Dar

Lone

, et al. Native arterio-venous fistula is the vascular access of choice for hemodialysis in end stage renal disease. Int Cardiovasc Res J 2013; 7: 67–70.

15.

Bashar

Zafar

Elsheikh

, et al. Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease. PLoS One 2015; 10: e0119958.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.04 MB