Vascular and Endovascular Techniques
VASCULAR AND ENDOVASCULAR TECHNIQUES
Thomas L. Forbes, MD, Section Editor
A novel technique of vascular anastomosis to prevent juxta-anastomotic stenosis following arteriovenous fistula creation
Ankit Bharat, MD, Mathew Jaenicke, and Surendra Shenoy, MD, PhD, St. Louis, Mo
Objectives: Juxta-anastomotic stenosis (JAS) is one of the predominant causes of arteriovenous fistula (AVF) failure, with the reported incidence as high as 65%. We hypothesized that technical modification to alter the outflow vein configuration using the novel piggyback Straight Line Onlay Technique (pSLOT) would prevent JAS and improve AVF maturation. Methods: Intention-to-treat analysis of the outcomes of consecutive distal radiocephalic (RC) fistulas performed by a single operator with three different anastomotic techniques using a prospectively maintained database. Traditional end-to-side technique (ETS), side-to-side straight-line onlay technique (SLOT, STS) and pSLOT in RC AVF created in 125 consecutive patients between 1/2004 and 12/2007 were compared. AVF maturation was evaluated by ultrasonography at 4 to 6 weeks and use for dialysis. Results: The mean age of the study group was 53.1 20.7 years, the male-to-female ratio was 61:64, and the races studied were African American (66; 52.8%) and Caucasian (54; 43.2%). The primary disease for renal failure was hypertension (54; 43.2%) and diabetes (51; 40.8%). Brachial artery flow at maturation was 1103 531 mL/min. Incidence of early JAS was 9.8% and late 14.6%. The clinico-demographic variables between ETS (n 57), STS (n 12), and pSLOT (n 54) were similar. The median follow-up between three groups: ETS (19 months), STS (12 months), and pSLOT (19 months; P .1), was similar. There was a significant decrease in JAS development in pSLOT patients (P .04). pSLOT patients also revealed decreased overall fistula failure (ETS 40.3%, STS 33.3%, pSLOT 16.7%; P .01). Conclusions: There was significant reduction in JAS and improvement in AVF maturation with
Thomas L. Forbes, MD, Section Editor
A novel technique of vascular anastomosis to prevent juxta-anastomotic stenosis following arteriovenous fistula creation
Ankit Bharat, MD, Mathew Jaenicke, and Surendra Shenoy, MD, PhD, St. Louis, Mo
Objectives: Juxta-anastomotic stenosis (JAS) is one of the predominant causes of arteriovenous fistula (AVF) failure, with the reported incidence as high as 65%. We hypothesized that technical modification to alter the outflow vein configuration using the novel piggyback Straight Line Onlay Technique (pSLOT) would prevent JAS and improve AVF maturation. Methods: Intention-to-treat analysis of the outcomes of consecutive distal radiocephalic (RC) fistulas performed by a single operator with three different anastomotic techniques using a prospectively maintained database. Traditional end-to-side technique (ETS), side-to-side straight-line onlay technique (SLOT, STS) and pSLOT in RC AVF created in 125 consecutive patients between 1/2004 and 12/2007 were compared. AVF maturation was evaluated by ultrasonography at 4 to 6 weeks and use for dialysis. Results: The mean age of the study group was 53.1 20.7 years, the male-to-female ratio was 61:64, and the races studied were African American (66; 52.8%) and Caucasian (54; 43.2%). The primary disease for renal failure was hypertension (54; 43.2%) and diabetes (51; 40.8%). Brachial artery flow at maturation was 1103 531 mL/min. Incidence of early JAS was 9.8% and late 14.6%. The clinico-demographic variables between ETS (n 57), STS (n 12), and pSLOT (n 54) were similar. The median follow-up between three groups: ETS (19 months), STS (12 months), and pSLOT (19 months; P .1), was similar. There was a significant decrease in JAS development in pSLOT patients (P .04). pSLOT patients also revealed decreased overall fistula failure (ETS 40.3%, STS 33.3%, pSLOT 16.7%; P .01). Conclusions: There was significant reduction in JAS and improvement in AVF maturation with
References: Submitted May 10, 2011; accepted Jul 25, 2011.