Track topics on Twitter Track topics that are important to you
End-stage renal disease (ESRD) arises from many heterogeneous disease pathways that alter the function and structure of the kidney irreversibly, over months or years.End-stage renal disease (ESRD) arises from many heterogeneous disease pathways that alter the function and structure of the kidney irreversibly, over months or years. Haemodialysis (HD) is a lifeline therapy for patients with ESRD. Our study to compare methods of AVF creation, side to side and end to side . This randomized controlled trial .
End-to-side versus side-to-side anastomosis with distal vein ligation for arteriovenous fistula creation: A prospective randomized controlled study
Introduction: Arteriovenous fistula (AVF) is the lifeline for patients with chronic renal failure on hemodialysis. The international guidelines recommend patient's referral for access replacement 6 months prior to predicted hemodialysis. The sites being preferred for access replacement are distal arm AVF, proximal arm AVF, basilic vein transposition or graft insertion, respectively (1) Meticulous preoperative assessment and patient selection play great role in achieving functioning AVF with long term patency. AVF maintenance always requires multi-disciplinary approach, with surgeons, nephrologist, dialysis nurses and the patients themselves working hand in hand. Any break in this circle will lead to failure of the AVF, and consequently, failure of hemodialysis. Surgical technique is of paramount importance for long term patency of AVF. There is an ongoing debate about the best technique to do the anastomosis between the artery and the vein; end to side, or side to side. This issue was addressed by very few randomized controlled studies (2,3,4).
Aim of the study: To compare the results of both surgical techniques for creation of arteriovenous anastomosis; End vein to side artery (ETS) versus Side vein to side artery (STS).
Patients and Methods
- Study location: Study protocol will be submitted for approval by Mansoura medical research ethics committee, faculty of medicine, Mansoura University.
- Study design: This is Prospective Randomized controlled trials that is going to be conducted at in department of vascular surgery Mansoura University Hospitals
- Time of study: The study will be conducted during the year 2017-2019.
- Study population: Study population will be on Patients referred to Vascular surgery department for creation of Hemodialysis access. Patients will be advised to undergo elective surgery for AVF once their renal Glomerular Filtration Rate Estimated (eGFR) is less than 15 ml/min.
- Inclusion criteria: All renal failure patients requiring creation of arm AVF, including distal Radio-cephalic, Ulno-basilic, proximal brachio-cephalic or brachio-basilic configurations
- Exclusion criteria: Revision AVF, Synthetic graft AVF or lower limb AVF, Patients with absent distal pulses and chronic ischemia of the upper limb and Recent cannulation of puncture of the vein within 2 weeks before its use in AVF creation.
- Primary End Point: Primary patency of Arterio-venous Fistula and Functional Maturation, ready fistula for cannulation, vein length at least 10 cm, diameter more than 6 mm, depth not more than 6 mm and ability of the access to deliver a flow rate 350 to 400ml/min and maintain dialysis for 4 hours.
- Secondary End Points: Secondary patency, Complication rate failure of maturation, bleeding, infection, steel syndrome and aneurysmal dilatation at anastomosis site
- Target number for recruitment: 50 patients in each group.
- Pre-operative assessment: All patients will undergo clinical assessment as well as routine duplex scan for marking of artery and a patent vein suitable for creation of AVF, with a minimum vein diameter of 2.5 mm for distal fistula and 3 mm for proximal ones.
- Method of Randomization: Computer based randomization.
- Surgical technique: Patients can have the procedure under general, local anesthetic or regional block according to suitability and patients' preference. Mobilization of the suitable artery and vein, creation of fistula using 6/0 prolene for anastomosis in continuous sutures, either ETS or STS with ligation of the distal end of the vein. Arteriotomy size will range from 7 to 10 mm for proximal AVF and from 12 to 15 mm for distal AVF, according to the size of the artery.
- Sites sharing in the study: Mansoura University Hospital
- Post-operative follow-up: Review in clinic on day 6, week 6, months 3 & 6, Duplex scan for assessment of flow in 6 weeks, 3 and 6 months.
Statistical analysis: The data was analyzed using Statistical Package for the Social Sciences. The Significant difference between the flow rate volume in both groups (continuous variable) will be verified by a two-sample test between the two groups. The data analyzed using Cochrane and ANOVA test. Categorical demographic variables were expressed as a proportion of the population and compared with a two-tailed Fisher's exact test.
Published on BioPortfolio: 2020-01-15T10:26:57-0500
Colour Coded Duplex Ultrasound of Native Arterio-venous Fistula for Haemodialysis With Venous Pressure Measurement Using Controlled Compression Ultrasound as a Predictor for Shunt Maturation in the Early Postoperative Phase
Prospective observational ultrasound study of native arterio-venous fistula for haemodialysis with venous pressure measurement using controlled compression ultrasound.
Home HD (HHD) is associated with better outcome in end-stage renal disease patients compared to in-center HD, in particular in terms of quality of life. However fear of AVF cannulation is ...
This is a prospective clinical study of the VasQ external support for arteriovenous fistulas. The device is designed to improve fistula outcomes by optimizing the geometrical configuration...
40000 patients are hemodialysis each year in France . In the case of chronic care, 78% of patients have an arteriovenous fistula. In order to perform the hemodialysis session, 2 technique...
For chronic hemodialysis patients, the creation of a well-functioning arteriovenous (AV) fistula is critical for ensuring that patient receive adequate hemodialysis. Unfortunately, the pri...
- Central venous stenosis and occlusion (CVO) is an increasing problem in the growing haemodialysis population. Sequelae include loss of access, loss of sites suitable for future venous access and ven...
To evaluate the efficacy of ultrasound or fluoroscopic-guided percutaneous transluminal angioplasty (PTA) combined with thrombolysis for the treatment of acutely thrombosed arteriovenous fistula (AVF)...
Postoperative pancreatic fistula (POPF) is the leading determinant of morbidity and mortality and reaches up to 49.9% of patients underwent pancreaticoenteric anastomosis during pancreaticoduodenectom...
Intraoperative retrograde blood flow from the vein to the lymphatic vessels in lymphaticovenular anastomosis (LVA) for lower extremity lymphedema (LEL) leads to poor results. This study aimed to estab...
Pure Pial arterial malformations (PAM) are poorly understood due to the limited number of reported cases. Because PAMs are thought to have a benign natural history these are generally managed conserva...
A vessel that directly interconnects an artery and a vein, and that acts as a shunt to bypass the capillary bed. Not to be confused with surgical anastomosis, nor with arteriovenous fistula.
Abnormal communication between two ARTERIES that may result from injury or occur as a congenital abnormality.
Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
An abnormal anatomical passage between the INTESTINE, and another segment of the intestine or other organs. External intestinal fistula is connected to the SKIN (enterocutaneous fistula). Internal intestinal fistula can be connected to a number of organs, such as STOMACH (gastrocolic fistula), the BILIARY TRACT (cholecystoduodenal fistula), or the URINARY BLADDER of the URINARY TRACT (colovesical fistula). Risk factors include inflammatory processes, cancer, radiation treatment, and surgical misadventures (MEDICAL ERRORS).
An abnormal anatomical passage that connects the VAGINA to other organs, such as the bladder (VESICOVAGINAL FISTULA) or the rectum (RECTOVAGINAL FISTULA).
Nephrology - kidney function
Nephrology is a specialty of medicine and pediatrics that concerns itself with the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy (dialysis and kidney transplantation). Systemic conditions...
Diabetes Diabetes Endocrine Disorders Obesity Oxycontin Renal Disease Thyroid Disorders Endocrinology is the study of the endocrine glands and the hormones that they secrete (Oxford Medical Dictionary). There are several g...