Comparison of Three Types of Distal Arteriovenous Fistulas: Snuffbox Fistula (SBAVF), Radiocephalic Fistula (RCAVF), and RCAVF With Venous Branch Patch

What this Trial Is About

Researchers are evaluating which type of distal arteriovenous fistula (SBAVF, RCAVF, or RCAVF with venous branch patch) is most clinically favorable for patients with chronic kidney disease (CKD) stage 4 or 5 who need vascular access for hemodialysis. The study recognizes that current guidelines do not specify which fistula type should be preferred initially, and the investigation aims to clarify differences in early and late success rates and maturation among these fistula types. The study involves creating one of three types of distal arteriovenous fistulas based on the patient's upper limb vascular anatomy assessed by Doppler ultrasound. Participants will be grouped into those receiving snuffbox fistula (SBAVF), radiocephalic fistula (RCAVF), or RCAVF with venous branch patch. The maturation of the fistula will be evaluated six weeks after surgery by measuring blood flow and vein diameter, using ultrasound to determine if the fistula is mature enough for effective hemodialysis. Participants will undergo detailed assessments including interviews for clinical history, physical examinations, and imaging studies of upper limb vessels before and after fistula creation. Blood samples and routine laboratory tests will be collected at baseline and during follow-up visits at specific intervals. The main outcomes measured are primary patency at 12 months and assisted primary and secondary patency at 36 months, with fistula maturation assessed at six weeks. Statistical analyses will compare outcomes across groups and consider patient characteristics that may influence fistula success.

Comparison of Three Types of Distal Arteriovenous Fistulas: SBAVF, RCAVF, and RCAVF With Venous Branch Patch.