What is it about?
Arteriovenous fistula (AVF) surgery is associated with variable but high rates of failure. We have evaluated the contribution of the surgical technique in this problem.
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Why is it important?
Since the first AVF was described in 1966 there has not been much technical innovation in this surgical procedure. The original side to side anastomosis which was associated with distal limb venous hypertension was replaced by the end to side anastomosis. SInce then people used the same technique in different sites with a similar failure rate. Author feels that lack of understanding of pathophysiological changes that drives the success of this procedure is the main reason behind the high failure rate. Recently a new technique called piggyback Straight Line Onlay Technique (pSLOT) was described. This technique is associated with a significantly higher rate of success with AVF surgery. More recently another technique termed the RADAR has claimed a better rate of success compared to the old technique.
Perspectives
The higher success rate using the technical alteration underscores the importance of understanding the role of hemodynamics in the problems associated with AV access. Understanding the effects of flow changes that are inherent to this surgical procedures has a potential to open avenues to prevent the problems that lead to the its failure.
surendra shenoy
Washington University in Saint Louis
Read the Original
This page is a summary of: Surgical technique determines the outcome of the Brescia/Cimino AVF, The Journal of Vascular Access, March 2017, SAGE Publications,
DOI: 10.5301/jva.5000698.
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