Arteriovenous Fistula (AVF) Formation: Comparison of End-to-Side and Side-to-Side Techniques in End Stage Renal Disease.

Abstract

Objective: To compare the success and complications of the side-to-side and end-to-side techniques of AV fistula formation. Study Design: A prospective randomized comparative analysis of 344 cases. Place and Duration of Study: The study was carried out from February 2006 to July 2010 in the Department of Urology, Punjab Medical College and Al-Noor Hospital Faisalabad. Subjects and Methods: A total number of 344 patients with end stage renal disease (ESRD) were included in the study for AV. fistula formation for Hemodialysis access. 304 patients completed their follow up. AV fistula was made by end-to-side and side-to-side techniques. Patients were followed after 24 Hours, 1 week, 1 month and 6 months after the operation. Results: These 304 patients were divided into 2 groups. Group 1 comprises of 154 patients and group 2 comprises of 150 patients. AV fistula worked successfully in 88.3%, 70.78%, 68.18% and 61.04% of 154 group 1 patients after 24 hours, one week, one month and six months followup respectively. AV fistula worked successfully in 76%, 65.33%, 63.33% and 58% of 150 group 2 patients after 24 hours, one followup respectively. Hemorrhage from fistula site was among 9.09%patients in group 1 and in 7.33% in group 2 patients after 24 hours of surgery while it was 2.6 % and 1.33% patients in group 1 and group 2 patients respectively after one moth follow up. Aneurysm was seen in 1.3% patients at one month and six months follow up respectively in group 1. It was seen in 0.67 and 1.33% patients at one month and six months follow up in group 2 patients. Ischemia was seen among 1.3% patients in group 1 and 8% in group 2 patients. No limb edema was present upto 1 week in any group. Odema was in 9.74% and 13% patients of group 1 patients at one month and six months follow up and 14.67% and 17.33% of group 2 patients at one month and six months follow up respectively. Conclusion: Both operative techniques for AV fistula formation are equally good for Hemodialysis access but complication rate with end-to-side technique is lower as compared to side-to-side technique.