Abstract
A retrospective review was performed of a prospectively maintained database at Yale-New Haven Hospital comparing a control group of patients between May 2013 and September 2014 and an experimental group between October 2014 and April 2017, and the results of a rat animal model. Of 201 patients who had undergone radial artery deviation and reimplantation (RADAR) arteriovenous fistulas (AVFs) vs 73 consecutive patients who had undergone control AVFs (C-AVFs), RADAR AVFs had significantly higher rates of maturation at 6 weeks and 3 months. The cumulative reintervention rate in the juxta-anastomotic segment was significantly lower in patients with RADAR compared with controls at 1 year (13% vs 43%) and 3 years (17% vs 49%). The 3-year primary (62% vs 38%) and secondary (95% vs 67%) patency rates were significantly increased in patients treated with RADAR compared with controls. No cases of hand ischemia occurred. In a rat animal model, the internal jugular vein was transposed onto the carotid artery, mimicking the geometry of C-AVFs on one side, and the contralateral carotid artery was transposed onto the jugular vein, mimicking the geometry of RADAR. Computed tomography and ultrasound determinations showed increased flow and decreased intimal hyperplasia with the RADAR configuration compared with the C-AVF configuration. RADAR is a durable surgical option for patients requiring radial-cephalic AVF.
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