Arteriovenous fistula: end-to-end or end-to side anastomosis?

The purpose of the present study was to compare the end-to-end (ETEa) with the end-to-side (ETSa) anastomosis in patients starting hemodialysis by means of radio-cephalic artero-venous fistulae (AVF). In our experience, we compared the results, as early failure (EF), late thrombosis (LT), stenosis, steal syndrome, and primary patency (PP), in 2 groups of hemodialysis incident patients that had been placed an AVF by means of ETEa or ETSa. The observation period lasted 24 months for each of the 2 types of AVF, starting from October 2005 to September 2007 for ETEa and from October 2007 to September 2009 for ETSa. One hundred forty patients were included in the present study. We have consecutively performed 99 AVF interventions at the wrist or at the third distal of the forearm, in 70 patients by means of ETEa and 82 AVF interventions in the same anatomical places in 70 patients by means of ETSa. The patients with ETEa had a mean age of 64.4 ± 14.6 years, males were 65.8% and the age dialysis at the end of observation was 10.4 ± 5.7 months. Those with ETSa had a mean age of 65.9 ± 15.5 years and the males were 62.9%, the age dialysis at the end of observation was 9.2 ± 5.5 months. The surgical team was composed by the same nephrologists. The statistical study was performed by means of the χ chi-square and Fisher's exact test. We have observed more late thrombosis (10% vs. 4.1%) and stenosis (21.4% vs. 2.7%) in ETEa than in ETSa. The number of early thrombosis was similar in the 2 types of anastomosis. The primary patency 1-year rate was better though not significantly in the ETS (80% vs. 85.7%) In our experience the ETSa provides, overall better results, both regarding the complications and primary survival than ETEa. For the benefits that seem to come from it, we believe, that a broad ETSa in the distal native AVF is preferable to the ETEa.