title: Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas for hemodialysis.
abstract: Although the end cephalic vein-to-side radial artery arteriovenous fistula is the "gold standard" procedure for primary hemodialysis access, it is associated with high rates of primary failure because of the development of neointimal hyperplasia and juxta-anastomotic stenosis. We report initial results of a new approach to perform radial-cephalic fistulas, radial artery deviation and reimplantation (RADAR), designed to avoid juxta-anastomotic stenosis.
  
  
  
  RADAR patients' data were prospectively maintained and retrospectively reviewed and compared with a historical control group of traditional radial-cephalic fistulas created in the same center. Duplex ultrasound was used to monitor maturation (flow ≥500 mL/min and venous diameter ≥5 mm) and to diagnose juxta-anastomotic stenosis. Study end points were rates of maturation, juxta-anastomotic stenosis, reintervention, and primary and secondary patency.
  
  
  
  There were 53 RADAR fistulas performed (follow-up, 10.5 ± 2.6 months) and compared with 73 control fistulas (follow-up, 12.0 ± 6.6 months). RADAR fistulas had increased rates of maturation compared with control fistulas (75% vs 45% at 6 weeks, P = .001; 92% vs 71% at 3 months, P = .003) and decreased incidence of juxta-anastomotic venous stenoses (2% vs 41%; P = .001). At 6 months, RADAR fistulas had increased primary patency (93% vs 53%; P < .0001) and secondary patency (100% vs 89%; P = .0003) and decreased incidence of reinterventions (10% vs 74%; P = .001) compared with control fistulas. No RADAR fistulas caused ischemic symptoms.
  
  
  
  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.
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; Medical School, University of Nice-Sophia Antipolis, Nice, France. Electronic address: sadaghianloo.n@chu-nice.fr.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Sadaghianloo
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; Medical School, University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Declemy
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; Medical School, University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Elixène
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; Medical School, University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Haudebourg
authors.affiliation: Department of Nephrology-Hemodialysis, Princess Grace Hospital, Monte Carlo, Monaco.
authors.forename: Christophe
authors.initials: C
authors.lastname: Robino
authors.affiliation: Medical School, University of Nice-Sophia Antipolis, Nice, France; Department of Nephrology-Hemodialysis, University Hospital of Nice, Nice, France.
authors.forename: Mohamed Shariful
authors.initials: MS
authors.lastname: Islam
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; Medical School, University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Réda
authors.initials: R
authors.lastname: Hassen-Khodja
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Conn; Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Conn.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012092:Replantation / Q000009:adverse effects; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*