The Effect of Distal Vein Branch Ligation in Side-to-Side Arterivenous Fistula on the Patency Rate and Complication in one Year

The most common vascular access for hemodialysis (HD) is arterivenous fistula (AVF). There are different methods for creation of fistula. In this study distal vein ligation (DVL) was evaluated for the purpose of finding a method with higher patency rate and lower complication rate. Between March 2000 to September 2003, 120 patients with end stage renal disease underwent AVF procedure. Patients randomized in two groups, half of them underwent DVL. AVF positions were 61 patients in snuffbox, 53 patients in antecubital and 6 patients in wrist. DVL performed in 25 AVFs in snuffbox and 29 AVFs in antecubital region. After one year complication and patency rate were compared in both groups. Twenty three (19.16%) AVFs with DVL in snuffbox had no complication and 27 (22.5%) AVFs without DVL in same region had no complication too. Six patients had wrist AVF with DVL that one of them was complicated in period of one year after procedure. In antecubital AVF, 9 (8%) cases with DVL and five (4.16%) cases without DVL had complicated (p>0.05). Patency rate was not different with or without DVL (p>0.05). For the purpose of accessing one simple technique with lower complication, DVL in side-to-side arterivenous fistula seems to convert this type of fistula to end to side fistula functionally. In this study DVL in snuffbox and antecubital region had no effect on complication and patency rate.