The RADAR technique in reconstruction of failed autologous arteriovenous fistulas due to juxta-anastomotic stenosis is equivalent to that with traditional surgery in maintenance hemodialysis patients.
Shuqi Xu, Jie Wang, Lijun Tang, Wei Cao, Liming Liang, Kai Wei, Zunsong Wang, Xianglei Kong
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引用次数: 0
Abstract
Objective: Autologous arteriovenous fistula (AVF) is recommended as superior vascular access for hemodialysis but has a high rate of failure, and juxta-anastomotic stenosis (JAS) is one of the predominant causes of fistula failure. The aim of this study was to compare the primary patency in reconstruction of failed AVFs due to JAS between the radial artery deviation and reimplantation (RADAR) technique and traditional surgery (end-vein to side-artery neo-anastomosis) in maintenance hemodialysis (MHD) patients.
Methods: A total of 1215 MHD patients with failed AVF were enrolled in this retrospective cohort study, and 614 patients with failed AVF received surgical intervention. Among these surgical interventions, 417 patients experienced AVF failure due to JAS. Finally, 25 patients who received the RADAR technique were enrolled. Controls of 50 patients received traditional surgery were randomly selected matched by age and sex. Clinical data such as age, sex, comorbidities, and blood biochemical indices were collected. Kaplan-Meier survival curves and Cox proportional hazards analyses were used to explore the difference between the RADAR group and the traditional group in reconstruction of failed AVFs.
Results: The RADAR group and the traditional group shared common baseline characteristics. The primary patencies of the reconstructed AVFs were 88.8%, 79.0%, 72.2%, 57.4%, and 38.3% at 12, 24, 36, 48, and 60 months among the 75 patients, respectively. Kaplan-Meier survival curve analysis demonstrated similar primary patencies in the two groups (log-rank test, p = 0.73). Compared with the traditional group, the RADAR group had no difference in predicting AVF failure after adjusting for potential confounders, with an HR of 0.92 (95% CI, 0.18-4.63).
Conclusions: The primary patency of the RADAR technique and the traditional surgery in the reconstruction of failed AVFs due to JAS is almost equal in 5 years.
期刊介绍:
The Journal of Vascular Access (JVA) is issued six times per year; it considers the publication of original manuscripts dealing with clinical and laboratory investigations in the fast growing field of vascular access. In addition reviews, case reports and clinical trials are welcome, as well as papers dedicated to more practical aspects covering new devices and techniques.
All contributions, coming from all over the world, undergo the peer-review process.
The Journal of Vascular Access is divided into independent sections, each led by Editors of the highest scientific level:
• Dialysis
• Oncology
• Interventional radiology
• Nutrition
• Nursing
• Intensive care
Correspondence related to published papers is also welcome.