2021 Volume 54 Issue 1 Pages 9-14
［Objectives］In the standard anastomosis method（functional side‒to‒end anastomosis） for the creation of arteriovenous fistulas（AVF） from autologous blood vessels, bending of the vein wall at the center of the anastomosis is sometimes experienced. We have devised a method to prevent such bending of the vein wall. We report on its usefulness.［ Method］The key points of this method are（1） to obliquely incise the vein wall and（2） to create an anastomosis using the upper and lower surfaces of the relevant artery and vein, respectively. The subjects were limited to cases in which an AVF was created using the radial artery and cephalic vein for the first time. We compared 52 cases involving the conventional method with 89 cases involving the venous wall oblique incision method. ［Results］There were no significant differences in patient background factors between the two groups. According to the Kaplan‒Meier method, the 1‒, 3‒, and 5‒year AVF primary patency rates in the conventional method and venous wall oblique incision method groups were 73.8％ vs. 76.8％, 47.5％ vs. 68.4％, and 38.1％ vs. 68.4％, respectively. The patency rates of the venous wall oblique incision group were significantly higher than those of the conventional method group（Log‒rank test, p＝0.0416）.［ Discussion and conclusion］A recent study based on computer simulations suggested that a change in hemodynamics is associated with the onset of shunt vessel stenosis after AVF anastomosis creation. Specifically, an increase in shunt blood flow disturbances might cause thickening of the inner surface of the shunt vessel, thrombus formation, and/or stenosis or obstruction of the shunt vessel. It is speculated that the reduction in venous wall bending at AVF anastomoses brought about by the venous wall oblique incision method might reduce blood flow disturbances in shunt vessels and improve AVF patency.
