Vol. 6, Issue 1, Part A (2024)

A radiocephalic arteriovenous fistula (AVF) is the preferred access method for hemodialysis (HD). The End-to-Side (ETS) anastomosis technique has been suggested to yield better outcomes compared to the Side-to-Side (STS) approach; however, there is limited evidence directly comparing the two methods. Given this, the present study aimed to evaluate and compare the outcomes of ETS and STS techniques in creating radiocephalic fistulas for end-stage renal disease (ESRD) patients. This quasi-experimental study was conducted in the Department of Urology at Sir Salimullah Medical College Mitford Hospital, Dhaka, over a 12-month period (May 2022 to April 2023) following ethical approval. A total of 74 ESRD patients requiring permanent vascular access for maintenance HD were enrolled, with 37 patients undergoing ETS AVF (Group A) and 37 patients receiving STS AVF (Group B). Postoperative follow-ups were conducted on the third day, as well as at the 6th and 12th weeks, using clinical evaluations, patient history, and investigations. Data were collected using structured case record forms and analyzed using SPSS 24.0. Baseline characteristics such as age, sex, and comorbidities were similar between the two groups. At the 6th week, maturation was observed in 78.4% of Group A patients compared to 48.6% in Group B, with the difference being statistically significant (p<0.05). Primary patency was recorded in 91.9% of Group A and 67.6% of Group B at the 6th week, and in 86.5% of Group A and 59.4% of Group B at the 12th week, both showing a significantly higher patency rate in Group A (p<0.05). Regarding postoperative complications, early thrombosis occurred in 5.4% of Group A patients versus 24.3% in Group B, while juxta-anastomotic stenosis was observed in 2.7% of Group A and 16.2% of Group B. Early thrombosis was significantly lower in Group A than in Group B (p<0.05). The study found no significant association between outcomes and age or gender in either group (p>0.05). Based on these findings, it can be concluded that the End-to-Side anastomosis technique is superior to the Side-to-Side approach for creating radiocephalic fistulas in ESRD patients, offering higher primary patency rates and better maturation outcomes.