Long-term outcomes of radiocephalic arteriovenous fistulas created in anatomical snuffbox or with VasQ external support device.

Abstract

This study evaluates the long-term outcomes of radiocephalic arteriovenous fistulas (RCAVFs) created in the anatomical snuffbox (SB-AVF) or with the VasQ external support device (ES-RCAVF). We conducted a single-center retrospective analysis including 394 primary AVFs created for hemodialysis access in patients with advanced kidney disease between November 2017 and October 2024. Outcomes examined included rates of access maturation, successful cannulation, patency (primary, assisted primary, and secondary), reintervention rates, and rates of juxta-anastomotic stenosis. Multivariate analyses were used to study the associations between baseline characteristics and clinical outcomes, aiming to identify variables that could inform algorithmic decision-making for optimal distal RCAVF configuration selection. The cohort consisted of 148 SB-AVFs and 246 ES-RCAVFs. ES-RCAVFs had significantly higher rates of 4-week maturation (81.9% vs 69.7%; P = .009), successful cannulation (82.6% vs 71.6%; P = .044), and tunneled dialysis catheter (TDC) removal (62.9% vs 56.9%; P = .28) at 6 months as compared with SB-AVFs. There was no significant difference in juxta-anastomotic stenosis rates (34% in the SB-group and 32% in the ES-group; P = .734) or 5-year patency rates between the two groups (26.1% vs 26.6% for primary [P = .531]; 51.2% vs 52.4% for assisted primary [P = .778]; and 56.5% vs 57.8% for secondary [P = .1278] patency rates) for the SB-AVF vs ES-RCAVFs, respectively. The number of interventions per patient year was 0.46 for SB-AVFs and 0.57 for ES-RCAVFs (P = .998). In the multivariate analysis, the VasQ significantly (P = .001) increased the probability of maturation, and female gender (P = .007) and diabetes (P = .026) significantly reduced that probability at 4 weeks. The VasQ also significantly increased the probability of overall maturation (P = .002). Female gender (P = .003) and older age (P = .028) negatively contributed to the probability of overall maturation. Moreover, VasQ significantly increased the probability of cannulation success (P = .034) and was the only significant factor for increased likelihood of TDC removal by 6 months (P = .031). Female gender (P = .002) and older age (P = .006) were associated with a significantly decreased likelihood of TDC removal. Our findings indicated that, although ES-RCAVFs achieve superior short-term and long-term outcomes, SB-AVFs remain a valuable option for select patients-particularly younger and nondiabetic individuals-to preserve distal access sites for future use.