Vascular Factors Affecting Outcomes of Snuffbox AV Fistula with Side-to-Side Anastomosis: A Single Institutional Observational Study

Angioaccess is considered the "Tendon of Achilles" for hemodialysis. Arteriovenous fistula (AVF) is the commonly entailed vascular access for hemodialysis.

The present study evaluates the outcomes of anatomical snuffbox AVF by preoperative and postoperative color Doppler scans. It also determines the anatomical snuffbox AVF maturation rate concerning preoperative radial artery diameter (RAD), cephalic vein diameter (CVD), cephalic vein distensibility, and peak systolic velocity (PSV).

This study was conducted from April 2020 to January 2021 on end-stage renal diseases (ESRD) patients undergoing an operation for anatomical snuffbox AVF creation at our center after taking permission from the institutional ethics committee and written informed consent from patients.

Thirty-five ESRD patients underwent snuffbox arteriovenous fistula (SBAVF) creation, including 68% males and 32% females. Diabetes mellitus was noted in 40% and hypertension in 80%. Successful AVF maturation was noted in 92% (69.57% of males and 30.43% of females). The mean RAD assessed on color Doppler ultrasonography (CDUS) preoperatively was 1.79 mm, while the peak velocity of the radial artery at the snuffbox was 23.80 cm/s.

We recommend applying the side-to-side configuration as its anastomosis angle is less owing to the lesser kink on the anastomotic site. A longer segment of anastomosis is achieved, and better fluid dynamics and WSS profiles are seen in this configuration with good outcomes.