{"title":"Beyond Conventional: A Systematic Review of Non-Conventional Techniques for Radio-Cephalic Arteriovenous Fistula.","authors":"Muskan Fatima Bhojani, Javeria Malik, Asma Mumtaz, Ziad Sophie, Summaiyya Waseem","doi":"10.1016/j.avsg.2024.07.091","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radio-cephalic arteriovenous fistulas (RC-AVFs), the preferred vascular access for hemodialysis, have high failure rates. New techniques like the no-touch technique (NTT) and modified no-touch technique (MNTT) have shown promising results. Our objective is to highlight the effectiveness of nonconventional techniques, aiming to address the challenge of arteriovenous fistula (AVF) failure.</p><p><strong>Methods: </strong>We searched Medline, Google Scholar, and Clinicaltrials.gov until April 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five relevant articles were found, all involving human studies on NTT or MNTT for RC-AVF creation. We focused on primary and secondary patency rates, fistula maturation rates, and complications.</p><p><strong>Results: </strong>We reviewed 5 studies as follows: 2 were pilot studies, 2 were prospective studies, and one was retrospective study. Three used NTT, and 2 used MNTT. Among double-arm studies, 3 out of 4 showed a significantly improved primary patency with nonconventional techniques. However, one study found no significant difference between nonconventional and conventional methods (90.5% vs. 84.2%; P = 0.225). In a single-arm study, nonconventional technique (NTT) displayed 54% primary patency at 1 year. Secondary patency rates were in 3 studies. One demonstrated significant secondary patency with nonconventional methods compared to conventional (90% vs. 67.5%; P = 0.028), while another found no significant difference (90.5% vs. 84.2%; P = 0.803). In the single-arm study, the nonconventional technique (NTT) revealed 80% secondary patency at 1 year.</p><p><strong>Conclusions: </strong>Nonconventional techniques (NTT and MNTT) show promise in improving patency rates, hinting at their potential as alternatives to the conventional technique for RC-AVF creation. Further studies are crucial to confirm their effectiveness and evaluate long-term outcomes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2024.07.091","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Radio-cephalic arteriovenous fistulas (RC-AVFs), the preferred vascular access for hemodialysis, have high failure rates. New techniques like the no-touch technique (NTT) and modified no-touch technique (MNTT) have shown promising results. Our objective is to highlight the effectiveness of nonconventional techniques, aiming to address the challenge of arteriovenous fistula (AVF) failure.
Methods: We searched Medline, Google Scholar, and Clinicaltrials.gov until April 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five relevant articles were found, all involving human studies on NTT or MNTT for RC-AVF creation. We focused on primary and secondary patency rates, fistula maturation rates, and complications.
Results: We reviewed 5 studies as follows: 2 were pilot studies, 2 were prospective studies, and one was retrospective study. Three used NTT, and 2 used MNTT. Among double-arm studies, 3 out of 4 showed a significantly improved primary patency with nonconventional techniques. However, one study found no significant difference between nonconventional and conventional methods (90.5% vs. 84.2%; P = 0.225). In a single-arm study, nonconventional technique (NTT) displayed 54% primary patency at 1 year. Secondary patency rates were in 3 studies. One demonstrated significant secondary patency with nonconventional methods compared to conventional (90% vs. 67.5%; P = 0.028), while another found no significant difference (90.5% vs. 84.2%; P = 0.803). In the single-arm study, the nonconventional technique (NTT) revealed 80% secondary patency at 1 year.
Conclusions: Nonconventional techniques (NTT and MNTT) show promise in improving patency rates, hinting at their potential as alternatives to the conventional technique for RC-AVF creation. Further studies are crucial to confirm their effectiveness and evaluate long-term outcomes.
期刊介绍:
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence