Comparison of Efficacy Outcome of Side to Side End to Side Radiocephalic Arteriovenous Fistula in Patients of Chronic Kidney Disease

Introduction: Chronic Kidney Disease (CKD) is a global health problem which is growing in prevalence. Hemodialysis is the most common treatment for end-stage renal disease (ESRD) which requires a permanent vascular access. Vascular accesses should have a good patency and low complication. Objectives: The present study aimed to compare the efficacy and outcome of side-to-side (STS) versus end-to-side (ETS) methods in radiocephalic arteriovenous fistulas in dialysis patients. Patients and Methods: In this randomized, single-blind clinical trial, 60 ESRD patients who required venous access for hemodialysis were divided equally into two groups. STS arteriovenous anastomosis was employed in one group and in the other, the ETS approach was conducted. Follow ups were done after 1, 6, and 24 weeks to detect fistula maturation and immediate or delayed complications. Results: The STS anastomosis group demonstrated higher rates of delayed maturation, vascular aneurism, and venous hypertension syndrome than ETS anastomosis group. The ETS group, however, showed higher rates of venous thrombosis and vascular stenosis. Overall, the rate of complications was 11% and 8% for STS and ETS anastomosis group respectively (P =0.03). Conclusion: In comparison, ETS arteriovenous fistulas involve less complications than STS method in ESRD patients. However, more thrombosis and stenosis detected by ETS method. ETS arteriovenous fistulas had less delayed maturation, aneurism, venous hypertension and overall complications than STS approach. ETS arteriovenous fistulas contribute to establishing a more stable connection to hemodialysis machine to conduct a more effective hemodialysis.