title: Arteriovenous fistulas constructed using side-to-side anastomosis with ligation and division of distal venous arm; a tertiary care hospital experience.
abstract: OBJECTIVE
  The rising prevalence of end-stage renal disease has added to the demands of renal replacement therapy in the form of hemodialysis (HD) in lieu of unmitigated needs of renal transplants. The best available angioaccess for HD is the autogenous arteriovenous fistula. Many techniques for arteriovenous anastomosis have been reported, but there is dearth of data which study the side-to-side arteriovenous anastomosis with concomitant ligation and division of the distal venous arm. This study aimed to describe the clinical outcome of the fistulae constructed with this particular technique.
  
  
  METHODS
  It is a descriptive and retrospective review in which all patients who underwent the operation with this particular technique in a certain time period were included. The data entry and analysis was done using SPSS 15. Only descriptive statistics are used. Demographic details, primary patency, end point patency and fistula survival were calculated.
  
  
  RESULTS
  There were 77 patients, 61 males and 16 females. Radiocephalic arteriovenous anastomosis was constructed in 65 patients, brachiocephalic in 11 patients and brachiobasilic in one patient. Primary patency was 96.1% and end point patency was 90.9% with a median survival of 44 weeks at the end point.
  
  
  CONCLUSIONS
  This particular technique of fistula construction has excellent patency rates, fistula survival and lesser complications when compared to what has been reported for other methods. It is therefore recommended that the technique of angioaccess reported in this study may be considered as a first option.
authors.affiliation: Urology and Kidney Transplant Department, Fatima Jinnah Medical College and Sir Ganga Ram Hospital, Lahore, Pakistan. zahsanurologist@yahoo.co.uk
authors.forename: Zafar-Ul
authors.initials: ZU
authors.lastname: Ahsan
authors.forename: Abdul
authors.initials: A
authors.lastname: Waheed
authors.forename: Faisal A
authors.initials: FA
authors.lastname: Zaeem
authors.forename: Farzana
authors.initials: F
authors.lastname: Nazir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001916:Brachial Artery; D016121:Brachiocephalic Veins / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D017534:Radial Artery / Q000601:surgery; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D055815:Young Adult