Radial artery deviation and reimplantation technique vs classical technique in arterio-venous fistula: A randomised control trial.

Abstract

Background: Surgically created arterio-venous fistulas (AVFs) are the gold standard for haemodialysis access for patients with end-stage renal disease. Standard practice of AVF creation involves selecting the non-dominant upper limb and starting with most distally with radio-cephalic arterio-venous fistula. The primary patency rate of radio-cephalic arterio-venous fistula varies from 20%-25%. It has been suggested the neointimal hyperplasia at the mobilized venous segment causes stenosis of the anastomosis. Therefore, the radial artery deviation and reimplantation (RADAR) technique, in which the vein is minimally mobilized, should result in a higher success rate.

Aim: To compare the RADAR technique with classical technique in creation of AVF including: (1) Success rate; (2) Time to maturation; (3) Duration of surgery; and (4) Complication rate.

Methods: In our study we recruited 94 patients in two randomized groups and performed the AVF by the classical method or the RADAR method.

Results: The RADAR group had higher primary success rate (P = 0.007), less rate of complications (P = 0.04), shorter duration of surgery (P = 0.00) and early time to maturation (0.001) when compared with the classical group. The RADAR procedure is a safe and a more efficient alternative to the current classical method of AVF creation. Longer duration of follow-up is required to assess the long-term outcomes in the future.

Conclusion: The RADAR procedure is a safe and more efficient alternative to the current classical method of AVF creation. Longer duration of follow-up is required to assess the long-term outcomes in the future.