Abstract: FR-PO766
A Randomised Controlled Trial of Interrupted versus Continuous Suturing Techniques for Radiocephalic Fistulae: 3-Year Follow-Up Data
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Aitken, Emma L., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
- Kingsmore, David, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
Background
Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of radiocephalic fistulae (RCF), however only 50-60% of RCF retain patency at one-year. We hypothesised that interrupted sutures (utilised in many microsurgical procedures) may improve outcomes of fistulae constructed from small vessels by optimising anastomotic compliance.
Methods
Three year follow-up of a randomised controlled trial comparing interrupted (n=36) vs. continuous (n=42) suturing techniques for RCF is presented. Patients were excluded if vessels were <1.8mm diameter or if previous ipsilateral fistula had been attempted. The primary end point was primary patency at 6 weeks (assessed by a blinded observer for the presence of thrill and bruit). Secondary end points were functional patency (clinical and ultrasonographic) at 6 weeks and primary/ secondary patency at 1 and 3 years (NCT01704313).
Results
Groups were comparable for basic patient demographics, operating surgeon and vessel diameter (mean age: 58.9(13.3) yrs; 67.9% male). Primary patency at 6 weeks was higher in the interrupted group (71.4% vs. 47.2%; OR 2.9 P=0.01). There was no significant difference in functional patency at 6 weeks (52.4% vs. 36.1%; OR 2.0 P=0.18). At 3 year follow-up 34.6% of patients (n=27) had died, 24.3% (n=19) had been transplanted and only 34.6% (n=27) of the patients remained on haemodialysis. Primary patency at 1 year was comparable between the two cohorts (53.3% [16 of 30 patients] vs. 45.9% [17 of 37 patients]; OR 1.34, P=0.17 for interrupted and continuous cohorts respectively). Similarly 3 year patency rates were 50.0% [13 of 26 patients] vs. 60.0% [15 of 25 patients]; OR 0.67, P=0.54).
Conclusion
An interrupted suturing technique yielded higher early primary patency rates for RCF. Less than one third of the original cohort remained on dialysis at three year follow-up. The early improvements in patency observed in the interrupted arm were not seen at 1 and 3 year follow-up. This may be the result of a small sample size (the study was not powered for secondary end-points). This study highlights the high attrition rate and short survival of patients with end-stage renal disease and brings into question whether autologous access is appropriate for ever patient.