Distally based V-flap on the artery in an end-to-side anastomosis for arteriovenous fistula creation – A randomized controlled pilot study

Abstract

With an increasing number of chronic kidney disease (CKD) patients presenting at a young age, it is necessary to create a vascular access (VA) that is reliable, long-lasting, and has minimal complications. Despite improvements in anastomotic techniques, distal arteriovenous fistula (AVF) has a high failure rate. The successful use of a geometric design for the end-to-side anastomosis in free tissue transfer led us to consider whether V-flap technique can be employed to achieve consistent and earlier maturation in distal AVF and reduce the failure rates. This was a prospective randomized controlled trial conducted between January and April 2022. Twenty CKD patients were randomized into two groups and underwent AVF creation using the slit-arteriotomy and the V-flap technique. Postoperative follow-up was performed on the 1st, 2nd, 4th, 6th, and 8th weeks. Cross-sectional area (CSA) and circumference of vein, linear and volumetric flow across the anastomosis, and the time taken to achieve AVF maturation were analyzed. There was a significant increase in the CSA and circumference in the V-flap group as compared to that in the slit-arteriotomy group. The volumetric flow across the anastomosis in the V-flap group was significantly higher than that of the slit-arteriotomy group. The median time to achieve AVF maturation in the slit-arteriotomy group was 8 weeks, whereas it was 4 weeks in the V-flap group. The V-flap technique creates an anastomosis with a greater CSA facilitating larger volumetric flow rate. This helps to achieve a consistent, reliable, and earlier maturation with successful initiation of hemodialysis.