الفهرس 
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Abstract
Radiocephalic autogenous arteriovenous fistulas (RCAVFs) are the first choice for the vascular dialysis
Although, failure rates of the conventional RC-AVF may be high due to thrombosis, juxta-anastomotic stenosis, failure to mature, and low fistula flow. Primary patency at 1 year is described to be around 58-63% in several studies but varies widely.
Juxta-anastomotic stenosis (JAS) is one of the predominant causes of arteriovenous fistula (AVF) failure, with the reported incidence of 65%. This lesion is always seen within 1 to 4 cm from the site of AVF anastomosis, resulting in luminal narrowing, decreased fistula flow leading to arrested maturation, and often early thrombosis. Although factors including handling of the tissues, suture technique, physiological changes related to increasing blood flow, shear stress, and patient- surgeon related variables have been implicated, the exact etiology of JAS still remains unclear. So, it was hypothesized that technical modification to alter the outflow vein configuration using the modified technique would prevent JAS and improve AVF maturation.
The study included 80 patients with chronic renal failure and prepared for dialysis.
Modified technique was performed in 40 patients and the other 40 patients had established fistula using conventional technique at vascular surgery unit in department of general surgery, Menoufia University Hospital. Patients were randomly classified into 2 groups using closed envelope method.
- The finding can be summarized in:
Both age and sex of the patients had a statistically insignificant relationship to the outcome of the procedures.
Primary failure in patient group was detected in 2 patients ( 5%) 1 month postoperative, while in control group 5 patients (12.5%) had primary failure, two of them 1 month postoperative and three were detected 1.5 month postoperative (p-value is 0.04).Duplex U.S was performed for all cases presented with 1ry failure and juxta-anastomotic stenosis was detected in the whole 7 cases and was attributed as the cause of primary shunt failure.
Patency assessment during follow up revealed that in ”patient group” 37 patients (92.5%) had functioning shunts after 3 months and one thrombosed shunt was detected with duplex U.S. After 6 months, 35 patients (87.5%) had patent shunts as 2 additional shunts were found thrombosed using duplex u.s. While In ”control group”, 34 patients (85%) had patent shunt after 3 months with one thrombosed A-V fistula , and 33 patients (82.5%) had patent shunts after 6 months with one additional thrombosed shunt diagnosed using duplex U.S .Therefore, there was a statistically significant difference between the two methods at 3 and 6 months (p-value is 0.02 and 0.03 respectively) . This means that the modified technique had better patency at 3 and 6 months postoperatively.
After 6 months, 2 cases in ”patient group” had weak thrill and Juxta-anastomotic stenosis was detected on duplex U.S examination, while 3 cases were detected in ”control group”. By the end of follow up period, the number of patients with JAS in group A was 4 (10 %), while group B had 8 patients (20 % ) , with p value of 0.01.This means statistically significant difference in JAS development between 2 techniques.
Complication rate was found statistically indifferent between two methods regarding pseudoaneurysm. One patient (2.5%) in group A and 2 patients (5%) in group B, with P value of 0.8.
Regarding infection , 2 patients (5%) had infection 1 week postoperative in group A with good response to antibiotics, while 3 patients (7.5%) had infection in group B 10 days postoperative and resolved on antibiotics (p-value 0.1),so no significant increase in incidence of infection between two groups