Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of the Efficacy and Complications of End-Side Anastomosis of Brachial Artery to Cubital Perforating Vein versus Side-Side Brachiocephalic Arteriovenous Fistula Formation in Hemodialysis Candidates

Document Type : Original Article (s)

Authors
Abbas Saroukhani 1
Arash Mehraz 2
1 Assistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Resident, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Corresponding Author: Arash Mehraz, Resident, Department of Surgery, School of Medicine, Isfahan University of Medical
10.22122/jims.v38i565.12826
Abstract
Background: Suitable vascular access is an important prerequisite for uncomplicated hemodialysis. The purpose of this study was to comparison the efficacy and complications of end-side anastomosis of brachial artery to cubital perforating vein versus side-side brachiocephalic arteriovenous fistula formation in hemodialysis candidates.Methods: In a clinical trial study, 85 patients undergoing arterial venous fistula placement were randomly divided in two groups of 42 and 43 patients. The first group was fed into the cephalic vein fistula to the adjacent brachial artery by side to side method, and in the second group, the cephalic vein fistula was transferred to the brachial artery by end to side method. The efficiency and duration of catheter operation were compared between the two groups.Findings: The mean duration of function of the fistula was 36.66 ± 2.34 weeks. The mean duration of fistula function in the two groups of side to side and end to side was 21.68 ± 2.03 and 38.4 ± 3.8 weeks, respectively, and there was no significant difference between the two groups according to the log-rank test (P = 0.41).Conclusion: The type of anastomosis in patients undergoing arteriovenous fistula does not have an effect on the efficacy and survival of fistula. However, since the lateral anastomosis has a greater flux of blood flow and less pressure in the vascular wall, this method seems to be preferred to anastomosis to the side shaft. At the same time, more studies are recommended.
Keywords
Arteriovenous fistula
Surgical anastomosis
Hemodialysis
  1. Lin CC, Yang WC. Prognostic factors influencing the patency of hemodialysis vascular access: Literature review and novel therapeutic modality by far infrared therapy. J Chin Med Assoc 2009; 72(3): 109-16.
  2. Ahmed I, Pansota MS, Tariq M, Tabassam SA, Saleem MS. Arterio-venous (AV) fistula: Surgical outcome and primaryfailure rate. J Univ Med Dent Coll 2012; 3(1): 27-32.
  3. Cronenwett JL, Johnston KW. Rutherford's vascular surgery references. 7th ed. Philadelphia, PA: Elsevier Science Health Science; 2010.
  4. Mozaffar M, Fallah M, Lotfollahzadeh S, Sobhiyeh MR, Gholizadeh B, Jabbehdari S, et al. Comparison of efficacy of side to side versus end to side arteriovenous fistulae formation in chronic renal failure as a permanent hemodialysis access. Nephrourol Mon 2013; 5(3): 827-30.
  5. Hossny A. Brachiobasilic arteriovenous fistula: Different surgical techniques and their effects on fistula patency and dialysis-related complications. J Vasc Surg 2003; 37(4): 821-6.
  6. Bender MH, Bruyninckx CM, Gerlag PG. The Gracz arteriovenous fistula evaluated. Results of the brachiocephalic elbow fistula in haemodialysis angio-access. Eur J Vasc Endovasc Surg 1995; 10(3): 294-7.
  7. Palmes D, Kebschull L, Schaefer RM, Pelster F, Konner K. Perforating vein fistula is superior to forearm fistula in elderly haemodialysis patients with diabetes and arterial hypertension. Nephrol Dial Transplant 2011; 26(10): 3309-14.
  8. Konner K, Lomonte C, Basile C. Placing a primary arteriovenous fistula that works--more or less known aspects, new ideas. Nephrol Dial Transplant 2013; 28(4): 781-4.
  9. Smart NA, Titus TT. Outcomes of early versus late nephrology referral in chronic kidney disease: A systematic review. Am J Med 2011; 124(11): 1073-80.
  10. Wong CS, McNicholas N, Healy D, Clarke-Moloney M, Coffey JC, Grace PA, et al. A systematic review of preoperative duplex ultrasonography and arteriovenous fistula formation. J Vasc Surg 2013; 57(4): 1129-33.
  11. Ene-Iordache B, Cattaneo L, Dubini G, Remuzzi A. Effect of anastomosis angle on the localization of disturbed flow in 'side-to-end' fistulae for haemodialysis access. Nephrol Dial Transplant 2013; 28(4): 997-1005.
  12. Moini M, Rasouli MR, Williams GM, Najafizadeh S, Sheykholeslami G. Comparison of side-to-side brachiocephalic arteriovenous fistula with ligation of the perforating vein with end-to-side brachiocephalic arteriovenous fistula. EJVES Extra 2009; 17(2): 7-10.
  13. Van Canneyt K, Pourchez T, Eloot S, Guillame C, Bonnet A, Segers P, et al. hemodynamic impact of anastomosis size and angle in side-to-end arteriovenous fistulae: A computer analysis. J Vasc Access 2010; 11(1): 52-8.
Journal of Isfahan Medical School
Volume 38, Issue 565 - Serial Number 565
January and February 2020
Pages 115-120

  • Receive Date 04 March 2020
  • Accept Date 06 April 2022