Comparison between radiocephalic arteriovenous fistula side to side anastmosis with and without distal vein runoff at gujranwala medical college/dhq hospital gujranwala

In hemodialysis vascular access is of prime importance. There are different types of techniques used for arteriovenous anastmosis.1) side to side anastmosis 2) end to side anastmosis,3) end of vein with end of artery. These different techniques are associated with different incidence of complications and patency. Objective: We intended to compare the efficacy of side to side anastmosis with distal vein ligation in terms of complication rate and patency rate with side to side anastmosis without distal vein ligation. Materials and Methods: We fashioned 60 radiocephalic fistula from January 2016 to May 2017 at DHQ teaching hospital Gujranwala which 30 patients were dealt with side to side anastmosis with distal vein runoff (group A) and 30 patients dealt with side to side anastmosis without distal vein runoff (group B).We compared data in terms of complications and patency rates after surgery performed at wrist between cephalic vein and radial artery. Results: During study period total 60 radiocephalic fistula were fashioned in which 30 patients were dealt with side to side anastmosis with ligating distal vein and 30 patients dealt with side to side anastmosis without distal vein ligation. There were 24 males(40%) and 36 (60%) females which were divided into two similar groups each having 12 males and 18 females irrespective of their age and their weight. The mean age was 49.63 years with standard deviation of 10.41 in Group A patients while in Group B patients mean age was 50.83 years with standard deviation of 11.0. Patency rate was 90 % with a p value of 0.9 in patients with distal vein runoff while it was 86.6 % with a p value of 0.8 in side to side anastmosis without distal vein runoff at 6 months. Surgical complications e.g post operative infection found 6.66 % in both groups 6df ccand numbness at thumb in 3.33 % in group A and 10 % in group B. Venous hypertension documented in 3.3% in group B patients and 0 % in group A patients. About 6.6 % patients of group B encountered aneurysm formation postoperatively while carpel tunnel syndrome symptoms not found postoperatively in any group. Conclusion: It is concluded that distal vein runoff should be the preferred option for Radiocephalic fistula as it is more efficacious in terms of patency rate with minimum complications.