Abstract
Introduction: Chronic Kidney Disease (CKD) is a global health problem which is growing in
prevalence. Hemodialysis is the most common treatment for end-stage renal disease (ESRD)
which requires a permanent vascular access. Vascular accesses should have a good patency
and low complication.
Objectives: The present study aimed to compare side-to-side (STS) versus end-to-side (ETS)
methods in antecubital arteriovenous fistulas in dialysis patients.
Patients and Methods: In this randomized, single-blind clinical trial, 100 ESRD patients who
scheduled for hemodialysis were divided into two groups. STS arteriovenous anastomosis
was employed in one group and in the other, the ETS approach was conducted. Follow ups
were done after 1, 8, and 24 weeks to detect fistula maturation and immediate or delayed
complications.
Results: The STS anastomosis group demonstrated higher rates of delayed maturation,
vascular aneurism, and venous hypertension syndrome than ETS anastomosis group. The
ETS group, however, showed higher rates of venous thrombosis and vascular stenosis. Overall,
the rate of complications was 24% and 8% for STS and ETS anastomosis group respectively
(P =0.03).
Conclusion: In comparison, ETS arteriovenous fistulas involve less complications than STS
method in ESRD patients. However, more thrombosis and stenosis detected by ETS method.
ETS arteriovenous fistulas had less delayed maturation, aneurism, venous hypertension
and overall complications than STS approach. ETS arteriovenous fistulas contributes to
establishing a more stable connection to hemodialysis machine to conduct a more effective
hemodialysis.