Reshaping Arteriotomy at the Corners Eases End-to-side Anastomosis: Results and Description of S-shaped Arteriotomy Technique

Abstract

Background: End to side anastomosis (ESA) poses difficulty at corners in small calibre vessels. S shaped arteriotomy (SSA) overcomes this. Aims: This study presents the results of SSA and explains the concept involved. Settings and Design: It is an observational study with retrospective analysis. Methods and Material: SSA coverts a narrow V at the corners into a broader U which pry open the edges. Altered dynamics acting on arterial wall result in this. SSA was utilised for carrying out arteriovenous fistulas [radio- cephalic and brachio-cephalic arteriovenous fistulas (AVFs)] and crural bypasses. The patency of AVFs was determined by doppler and / or ability to carry out successful dialysis. Crural bypass were followed by doppler and/ or CT angiography for patency. Statistical Analysis Used: Results are presented as a descriptive analysis. Results: One hundred ESAs were done. This included sixty- five radio cephalic AVFs, twenty brachio-cephalic AVFs and fifteen femoro-crural bypasses. The mean diameter of the radial artery was 1.97 +/- 0.24mm; while the average diameter of brachial artery was 3.3 +/- 0.43mm; and that of crural arteries was 2.4 +/- 0.43mm. Twelve radio cephalic AVFs thrombosed, but rest of AVFs matured with a mean follow up of 6 months. The total follow up for crural bypasses was 21 months. The cumulative patency rate was 100 percent at 10 months and 82% at 21 months. Conclusions: SSA helps in better visualising of the corners and facilitates ESA with satisfactory results. This happens due to redistribution of forces acting on the arterial wall.

Keywords

• arteriovenous fistula
• end-to-end anastomosis
• femoro-crural bypass
• longitudinal arteriotomy
• s-shaped arteriotomy