Outcomes of Snuffbox Arteriovenous Fistula as a First Line Approach to Dialysis Access in Patients with End Stage Kidney Disease.

Abstract

Objective: The persistent shortage of organs for kidney transplantation necessitates long-term renal replacement therapies like hemodialysis. Arteriovenous fistula (AVF) creation is a well-established method for vascular access to be used for hemodialysis, with the wrist radio-cephalic AVF being common. While the anatomical snuffbox radio-cephalic AVF is less frequently used, it remains a potential site for AVF creation. The objective of this study was to evaluate our long-term outcomes of using the snuffbox arteriovenous fistula as a first-line approach for vascular access in patients with end-stage kidney disease.

Methods: This retrospective single center study included all patients undergoing primary snuffbox AVF creation at our institution from November 2005 to December 2022. Preoperative ultrasound assessed vessel suitability for the procedure. Procedures were performed under local anesthesia with procedural sedation, involving dissection of the radial artery and cephalic vein within the anatomical snuffbox, and side-to-side anastomosis. Post-procedure, patients were followed for fistula patency. Data collected included demographics, baseline laboratory values, comorbidities, previous vascular access, and anticoagulant use. Primary patency and primary assisted patency was analyzed.

Results: Snuffbox AVF procedures were performed on 258 patients (77.9% male, median age 53 years). Primary patency rates were 94% at 1 month, 87% at 6 months, and 79% at 1 year. 6.6% of patients required endovascular intervention. 18.6% underwent kidney transplantation. No deaths were related to fistula creation.

Conclusion: Snuffbox arteriovenous fistulas are a safe and viable alternative to wrist AVF in suitable candidates, demonstrating comparable rates of complications and patency. Snuffbox AVF can help patients maintain long-term vascular access for dialysis and while awaiting transplant.