Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas for hemodialysis

Sadaghianloo, Nirvana; Declemy, Serge; Jean-Baptiste, Elixène; Haudebourg, Pierre; Robino, Christophe; Islam, Mohamed Shariful; Hassen-Khodja, Réda; Dardik, Alan

doi:10.1016/j.jvs.2016.04.023

Cited by 39 publications

(38 citation statements)

References 28 publications

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“…AVFs with surgical intervention for FTM had a similar one year cumulative patency to those AVFs that did not require intervention to promote maturation. 60 Similar results were found in a consecutive series of 73 patients with AVF non-maturation and JAS, treated either by surgery (21) or PTA (52). Surgery meant creation of a proximal neo-anastomosis excluding the area of stenosis.…”

Section: Operative Surgical and Endovascular Methods To Improve Avf Msupporting

confidence: 67%

“…At 6 months, RADAR fistulae had increased primary patency (93% vs. 53%; p < .0001) and secondary patency (100 vs. 89%; p ¼ .0003) and decreased incidence of re-interventions (10% vs. 74%; p ¼ .001) compared with control fistulae. 21 Use of anastomotic devices. The Optiflow (Bioconnect Systems, Ambler, Pa, USA) is an internal anastomotic connecting device placed inside the artery and vein, with the purpose of improving haemodynamics and standardising AVF creation.…”

Section: Operative Surgical and Endovascular Methods To Improve Avf Mmentioning

confidence: 99%

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Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Tordoir

Zonnebeld

Loon

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Operative Surgical and Endovascular Methods To Improve Avf Msupporting

confidence: 67%

Section: Operative Surgical and Endovascular Methods To Improve Avf Mmentioning

confidence: 99%

Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Tordoir

Zonnebeld

Loon

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…The new RADAR technique to create AVF, e.g. minimizing venous handling and potential for wall ischemia, alters hemodynamics and may be a simple and low-cost method to improve access patency [239]. …”

Section: Future Approaches To Treatmentmentioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

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With the increasing prevalence of end stage renal disease there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes, in the setting of uremia, systemic inflammation, oxidative stress and preexistent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis, as well as development of neointimal hyperplasia (NIH) that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to NIH involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure, based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure requires a multidisciplinary approach involving nephrologists, vascular surgeons and interventional radiologists, allowing careful patient selection and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.

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“…Current evidence highlights the role of outflow vein configuration in AVF maturation. Minimal alteration of vein wall configuration and avoidance torsion, technique improves AVF maturation 14. Regarding infection, there was no significant increase in incidence of infection between two groups.…”

mentioning

confidence: 84%

Modified technique of end to side distal radio-cephalic shunt to overcome juxta-anastomotic stenosis

et al. 2019

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Background: Juxta-anastomotic stenosis (JAS) is one of the predominant causes of arteriovenous fistula (AVF) failure, with the reported incidence of 65%, so that technical modification to alter the outflow vein configuration using the modified technique has been applied to prevent JAS and improve AVF maturation. The aim of the study to evaluate the modified technique of end-to-side distal radiocephalic A-V fistula regarding maturation, patency rate and the resultant juxta-anastomotic stenosis.Methods: This prospective study was carried out on 80 patients with end stage renal disease (ESRD) at vascular surgery unit in general surgery department, Menoufia university hospital that prepared for dialysis. 40 patients "intervention group" underwent the modified technique to establish a functioning radiocephalic fistula; the other group (40 patients, control group) had the conventional technique of end to side radiocephalic fistula. Follow up of patients was over 6 months regarding function, patency rate and development of juxta-anastomotic stenosis.Results: There was statistically significant difference between 2 groups regarding primary failure, patency and JAS. Primary failure was detected in 2 patients in group A and in 5 patients in group B (p-value is 0.04). Considering patency rate, after 3 months the ratio between group A and group B was 37:34 with significant P value of 0.02, and after 6 months the ratio was 35:33 with P value of 0.03. Regarding JAS, by the end of follow up period, 4 patients diagnosed with JAS in group A, while group B had 8 patients, with p value of 0.01.Conclusions: Modified technique of end to side anastomosis for primary radio-cephalic fistula creation has better patency rate and low incidence of JAS than conventional method.

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Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas for hemodialysis

Abstract: The RADAR technique is associated with less juxta-anastomotic stenosis, increased maturation and patency, and fewer secondary interventions. These improved outcomes suggest that RADAR may be the preferred surgical technique to perform radial-cephalic arteriovenous fistula.

Cited by 39 publications

References 28 publications

Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence

Future research directions to improve fistula maturation and reduce access failure

Modified technique of end to side distal radio-cephalic shunt to overcome juxta-anastomotic stenosis

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