Arteriovenous fistula [AVF] formation: comparison of end-to-side and side-to-side techniques in end stage renal disease

ABSTRACT

To compare the success and complications of the side-to-side and end-to-side techniques of AV fistula formation. A prospective randomized comparative analysis of 344 cases. The study was carried out from February 2006 to July 2010 in the Department of Urology, Punjab Medical College and Al-Noor Hospital Faisalabad. 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. 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 up to 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. 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