Randomized Controlled Trial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jun 25, 2025; 14(2): 100092
Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.100092
Radial artery deviation and reimplantation technique vs classical technique in arterio-venous fistula: A randomised control trial
Shakti S Sarangi, Shashank Kumar, Deepak P Bhirud, Mahendra Singh, Shiv C Navriya, Gautam Ram Choudhary, Arjun Singh Sandhu
Shakti S Sarangi, Shashank Kumar, Deepak P Bhirud, Mahendra Singh, Shiv C Navriya, Gautam Ram Choudhary, Arjun Singh Sandhu, Department of Urology, All India Institute of Medical Sciences, Jodhpur 342005, Rājasthān, India
Co-first authors: Shakti S Sarangi and Shashank Kumar.
Co-corresponding authors: Deepak P Bhirud and Mahendra Singh.
Author contributions: Sarangi SS was involved in the concept, idea, and design; Sarangi SS, Singh M, and Bhirud DP made executive contributions to the manuscript; Singh M, Bhirud DP, and Kumar S contributed to the manuscript for clinical studies, data collection; Navriya SC, Choudhary GR, and Sandhu AS contributed to implementation in patients; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of All India Institute of Medical Sciences, approval No. AIIM/IEC/2021/3324.
Clinical trial registration statement: Clinical trial registration, approval No. CTRI/2022/05/042638.
Informed consent statement: Patient consent was obtained for this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deepak P Bhirud, Assistant Professor, Department of Urology, All India Institute of Medical Sciences, Type 2 residence, AIIMS Campus, Jodhpur 342005, Rājasthān, India. deepakprakashbhirud05@gmail.com
Received: August 7, 2024
Revised: January 15, 2025
Accepted: January 23, 2025
Published online: June 25, 2025
Processing time: 245 Days and 11.2 Hours
Abstract
BACKGROUND

Surgically created arterio-venous fistulas (AVFs) are the gold standard for haemodialysis access for patients with end-stage renal disease. Standard practice of AVF creation involves selecting the non-dominant upper limb and starting with most distally with radio-cephalic arterio-venous fistula. The primary patency rate of radio-cephalic arterio-venous fistula varies from 20%-25%. It has been suggested the neointimal hyperplasia at the mobilized venous segment causes stenosis of the anastomosis. Therefore, the radial artery deviation and reimplantation (RADAR) technique, in which the vein is minimally mobilized, should result in a higher success rate.

AIM

To compare the RADAR technique with classical technique in creation of AVF including: (1) Success rate; (2) Time to maturation; (3) Duration of surgery; and (4) Complication rate.

METHODS

In our study we recruited 94 patients in two randomized groups and performed the AVF by the classical method or the RADAR method.

RESULTS

The RADAR group had higher primary success rate (P = 0.007), less rate of complications (P = 0.04), shorter duration of surgery (P = 0.00) and early time to maturation (0.001) when compared with the classical group. The RADAR procedure is a safe and a more efficient alternative to the current classical method of AVF creation. Longer duration of follow-up is required to assess the long-term outcomes in the future.

CONCLUSION

The RADAR procedure is a safe and more efficient alternative to the current classical method of AVF creation. Longer duration of follow-up is required to assess the long-term outcomes in the future.

Keywords: Radial artery deviation and reimplantation technique; Classical technique; Arterio-venous fistula; Arterio-venous fistula trial; Dialysis fistula; Chronic kidney disease

Core Tip: Creating an arterio-venous fistula is a complex surgical procedure that often faces high failure rates. Ensuring appropriate patient selection and thorough preoperative optimization are crucial for successful outcomes. The radial artery deviation and reimplantation procedure offers a safer and more efficient alternative to the traditional method of arterio-venous fistula creation. However, extended follow-up is necessary to evaluate its long-term effectiveness.