Mohammad Zarin, Israr Ahmad, Dastgeer Waheed, Ahmad Zeb, Nisar Anwar, Viqar Aslam, Tahir Ayub, Zahid Haider.
Arteriovenous fistula construction in chronic Hemodialysis patients: comparison of end-toside and side-to-side techniques.
J Coll Physicians Surg Pak Jan ;14(10):619-21.

Objective: To compare the techniques of end-to-side and side-to-side anastomosis in arteriovenous fistulae construction in terms of success rate and immediate postoperative complications. Design: Comparative study. Place and Duration of Study: Ayub Hospital Complex, Abbottabad, from October 1999 to December 2002 and Khyber Teaching Hospital, Peshawar, from January 2003 to December 2003. Patients and Methods: One hundred and ninety patients with end stage renal disease (ESRD) were included in the study. Arteriovenous fistula was constructed in these patients by two techniques i.e. end-to-side and side-to-side anastomosis. The two methods were compared in terms of duration of surgery, immediate success rate and short-term complications. Results: Among 190 patients, 118 (62%) were males and 72 (38%) females. The age ranged between 24 to 66 years with average age of 54 years. Side-to-side anastomosis was done in 120 (63%) patients while end-to-side in 70 (37%) patients. The average duration of surgery in side-to-side group was 50 minutes and in end-to-side group it was 75 minutes. Bleeding occurred in 4(5.7%) cases in end-to-side group and 2(1.7%) patients in side-to-side group requiring reexploration. The immediate failure rate of the procedure was 2.5% in side-to-side group and 7.5% in end-to-side group. Wound infection occurred in 1(1.4%) case in end-to-side group and 2(1.7%) cases in side-to-side group. Conclusion: In patients with end stage renal disease (ESRD) arteriovenous fistula construction by side-to-side anastomosis is less time-consuming and has less complications as compared to end-to-side technique.

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