Comparison between the Techniques of Radiocephalic Arteriovenous Fistulas for Haemodialysis: A Retrospective Analytical Study

Abstract

Introduction: Chronic Kidney Disease (CKD) has become a major health issue worldwide. CKD patients require Renal Replacement Therapy (RRT) throughout their life. Haemodialysis is one of the options for RRT. Arterio-Venous Fistula (AVF) creation is required for haemodialysis. The radiocephalic fistula is the initial option for creating vascular access. Fistula can be created by anastomosing cephalic vein to radial artery either by End-To-Side (ETS) or Side-To-Side (STS) techniques. Aim: To compare the efficacy rate of radiocephalic AVF using ETS or STS anastomotic methods. Materials and Methods: This was a retrospective analytical study conducted at SDM college of medical sciences and hospital, Dharwad from March 2017 to February 2020. A total of 43 CKD patients were enlisted for the above duration from the hospital records. These patients were included in the study since they underwent radiocephalic AVF creation. AVF creation at other anatomical sites for rest of the CKD patients was excluded. Out of 43 patients, 24 of them underwent ETS technique and 19 STS technique; 15 patients from the former group and 17 from the latter were followed-up for a period of three months. Eleven patients were lost to followup. Demographic variables were analysed with frequency, mean and standard deviation. Its association with two different operative techniques was analysed using Fisher’s-exact test. Outcome of the two operative procedures was analysed using Student’s t-test. Results: Effectively 15 patients from ETS group and 17 from STS group were compared. Three (20%) in ETS group and 5 (29.41%) in STS group had primary failure. Mean of maturation time in weeks in ETS group was 4.73±2.73 weeks and in STS group was 5.29±3.75 weeks. Three months patency rate in ETS group was 12 (80%) and in STS group was 12 (70.58%). Student’s t-test was performed comparing the above parameters and no statistical significance was noted. Conclusion: Comparison of two techniques of radiocephalic AVF creation proves that both the techniques are beneficial with no superiority of one over other.

Keywords

• chronic kidney disease
• end stage renal disease
• end-to-side technique
• side-to-side technique