Optimization of the surgical arteriovenous fistula for end-stage renal disease
Objective: It is widely acknowledged that an arteriovenous fistula (AVF) is the optimal vascular access for dialysis; however, the reported outcomes following AVF creation vary widely, with primary patency rates that range from 50% to 65% at 1 year. Many adaptations of the original procedure have be...
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Elsevier
2025-01-01
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| Series: | JVS-Vascular Insights |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949912725000303 |
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| author | David B. Kingsmore, MD, FRCS, Mb ChB, BMEdBiol Ben Edgar, FRCS, Mb ChB Karen Stevenson, PhD, FRCS, Mb ChB, BSc (MedSci) |
| author_facet | David B. Kingsmore, MD, FRCS, Mb ChB, BMEdBiol Ben Edgar, FRCS, Mb ChB Karen Stevenson, PhD, FRCS, Mb ChB, BSc (MedSci) |
| author_sort | David B. Kingsmore, MD, FRCS, Mb ChB, BMEdBiol |
| collection | DOAJ |
| description | Objective: It is widely acknowledged that an arteriovenous fistula (AVF) is the optimal vascular access for dialysis; however, the reported outcomes following AVF creation vary widely, with primary patency rates that range from 50% to 65% at 1 year. Many adaptations of the original procedure have been proposed to improve outcomes, but the evidence to support these is unclear and often conflicting. The aim of this article is to review the published literature on defined technical approaches to improve outcomes and determine the key technical aspects. Methods: Relevant literature was identified by searching Medline, Embase, and Cochrane databases using terms for arteriovenous fistula, technique, and modification. In addition, secondary referencing was performed. Studies including technical approaches or modifications were reviewed. All other reports of pre- or post-creation intervention/revisions/medication and not in English were excluded. Results: From 3302 records, 81 relevant studies were reviewed and referenced. Four main types of AVF procedure have been described: a traditional approach, piggyback straight-line on-lay technique (pSLOT), not-touch technique, and radial artery deviation and reimplantation (RADAR). Randomized trials have been performed in seven technical steps to optimize the outcome of the traditional AVF (control of blood vessels, intra-luminal probes, an excision arteriotomy, anastomosis technique, anastomotic angle, interrupted suture technique, blood vessel dilatation). Other techniques (pSLOT, not-touch, RADAR) have conflicting rationale and techniques, but still report excellent outcomes. Conclusions: This review does not support the concept of a single ‘ideal’ AVF operation that applies to all circumstances. Although there appear to be opposite philosophical views between all four techniques, all are marked by a thoughtful, adaptive, meticulous approach, implying that the key variable in determining the outcome is the surgeon, rather than a prescribed procedure. |
| format | Article |
| id | doaj-art-022a9f58a47d426e84e63e026ad15285 |
| institution | DOAJ |
| issn | 2949-9127 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JVS-Vascular Insights |
| spelling | doaj-art-022a9f58a47d426e84e63e026ad152852025-08-20T03:09:48ZengElsevierJVS-Vascular Insights2949-91272025-01-01310021310.1016/j.jvsvi.2025.100213Optimization of the surgical arteriovenous fistula for end-stage renal diseaseDavid B. Kingsmore, MD, FRCS, Mb ChB, BMEdBiol0Ben Edgar, FRCS, Mb ChB1Karen Stevenson, PhD, FRCS, Mb ChB, BSc (MedSci)2School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom; Correspondence: David B. Kingsmore, MD, FRCS, Mb ChB, BMEdBiol, Renal Surgery and Transplant Unit, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, United KingdomSchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United KingdomGlasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United KingdomObjective: It is widely acknowledged that an arteriovenous fistula (AVF) is the optimal vascular access for dialysis; however, the reported outcomes following AVF creation vary widely, with primary patency rates that range from 50% to 65% at 1 year. Many adaptations of the original procedure have been proposed to improve outcomes, but the evidence to support these is unclear and often conflicting. The aim of this article is to review the published literature on defined technical approaches to improve outcomes and determine the key technical aspects. Methods: Relevant literature was identified by searching Medline, Embase, and Cochrane databases using terms for arteriovenous fistula, technique, and modification. In addition, secondary referencing was performed. Studies including technical approaches or modifications were reviewed. All other reports of pre- or post-creation intervention/revisions/medication and not in English were excluded. Results: From 3302 records, 81 relevant studies were reviewed and referenced. Four main types of AVF procedure have been described: a traditional approach, piggyback straight-line on-lay technique (pSLOT), not-touch technique, and radial artery deviation and reimplantation (RADAR). Randomized trials have been performed in seven technical steps to optimize the outcome of the traditional AVF (control of blood vessels, intra-luminal probes, an excision arteriotomy, anastomosis technique, anastomotic angle, interrupted suture technique, blood vessel dilatation). Other techniques (pSLOT, not-touch, RADAR) have conflicting rationale and techniques, but still report excellent outcomes. Conclusions: This review does not support the concept of a single ‘ideal’ AVF operation that applies to all circumstances. Although there appear to be opposite philosophical views between all four techniques, all are marked by a thoughtful, adaptive, meticulous approach, implying that the key variable in determining the outcome is the surgeon, rather than a prescribed procedure.http://www.sciencedirect.com/science/article/pii/S2949912725000303Arteriovenous fistulaSurgeryOutcomesEvidence |
| spellingShingle | David B. Kingsmore, MD, FRCS, Mb ChB, BMEdBiol Ben Edgar, FRCS, Mb ChB Karen Stevenson, PhD, FRCS, Mb ChB, BSc (MedSci) Optimization of the surgical arteriovenous fistula for end-stage renal disease JVS-Vascular Insights Arteriovenous fistula Surgery Outcomes Evidence |
| title | Optimization of the surgical arteriovenous fistula for end-stage renal disease |
| title_full | Optimization of the surgical arteriovenous fistula for end-stage renal disease |
| title_fullStr | Optimization of the surgical arteriovenous fistula for end-stage renal disease |
| title_full_unstemmed | Optimization of the surgical arteriovenous fistula for end-stage renal disease |
| title_short | Optimization of the surgical arteriovenous fistula for end-stage renal disease |
| title_sort | optimization of the surgical arteriovenous fistula for end stage renal disease |
| topic | Arteriovenous fistula Surgery Outcomes Evidence |
| url | http://www.sciencedirect.com/science/article/pii/S2949912725000303 |
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