A prospective study of end-to-side vs. side-to-side arteriovenous fistulas for haemodialysis.
In an attempt to determine the optimum configuration of arteriovenous (A-V) fistulas for haemodialysis, 71 patients were prospectively randomized to undergo either a side-to-side or end-of-vein to side-of-artery A-V fistula. Nine months after operation, the patency rates on dialysis were almost identical in the two groups (79.2 per cent and 78.6 per cent respectively). However, 7 of the 32 side-to-side fistulas developed hyperaemia of the hand, three of which required revisional surgery. Hyperaemia of the hand has not been seen with end-to-side fistulas. In addition, peroperative measurements of fistula flow appeared to have prognostic value with end-to-side but not with side-to-side fistulas. It is suggested that the end-to-side configuration is the one of choice for the formation of A-V fistulas for haemodialysis.
D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D011897:Random Allocation; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013927:Thrombosis / Q000209:etiology; D014953:Wrist / Q000098:blood supply