Abstract: Objective  To investigate the effect of side-to-side anastomosis technique on the function of forearm autologous arteriovenous fistula (AVF) in end-stage renal disease (ESRD) patients with hemodialysis (HD).  Methods Patients undergoing forearm AVF surgery at the Kidney Disease Medical Center of Weifang People's Hospital from May 2019 to September 2021 were enrolled in this study. They were divided into two groups based on the vascular anastomosis technique, end-to-side anastomosis group and side-to-side anastomosis group. Surgical success rate and postoperative complications were compared between the two groups. COX regression was used to analyze the relationship between various factors and AVF patency. Kaplan-Meier survival analysis was used to analyze the primary patency rate and cumulative patency rate in overall patients and the two groups.  Results  A total of 218 patients were included, with 123 in the end-to-side anastomosis group and 95 in the side-to-side anastomosis group. There were no statistical differences in surgical success rate (χ2=0.017, P=0.897), median AVF blood flow after the operation for 8 weeks (Z=-1.820, P=0.069), and postoperative severe limb swelling (P=0.189) between the two groups. Multifactorial COX proportional risk regression model analysis showed that female was a negative factor for AVF cumulative patency (HR=4.603, 95% CI:1.548～13.770, P=0.006), and AVF side-to-side anastomosis was a positive factor for AVF cumulative patency period as compared with that of end-to-side anastomosis (HR=0.307, 95% CI:0.112～0.845, P=0.022). In overall patients after the operation for 12 and 24 months, the primary AVF patency rates were 73.9% and 57.9% respectively, and the cumulative patency rates were 95.2% and 87.75 respectively. AVF cumulative patency rate was statistically different between the two groups (χ2=4.172, P=0.041), while AVF primary patency rate had no statistical difference (χ2=2.816, P=0.093).  Conclusion   Side-to-side anastomosis for constructing forearm proximal radial-cephalic AVF is a safe and effective operation for HD patients, with better cumulative patency than that of end-to-side anastomosis technique.

Key words: Side-to-side anastomosis, Arteriovenous fistula, Hemodialysis, End-stage renal disease