A Trial of Interrupted vs Continuous Suturing Techniques for Radiocephalic Fistulae
A Trial of Interrupted vs Continuous Suturing Techniques for Radiocephalic Fistulae
Patients with end-stage renal failure require dialysis to remove toxins from their blood.
 Haemodialysis is best provided through a native arterio-venous fistula (AVF). Creation of an
 AVF requires a short (~1hr) surgical procedure to join the artery and vein together.

 There are limited potential sites for fistula creation. Generally it is preferrable to
 utilise the most distal sites at the wrist first, as more proximal elbow procedures preclude
 subsequent use of the wrist should the initial fistula fail. The small diameter of artery and
 vein at the wrist requires precise surgical technique.

 There are two potential techniques in common use for creating the arterio-venous anastomosis
 (the join between artery and vein) - continuous suturing and interrupted sutures. Whilst
 there are theoretical advantages to the interrupted technique, it is uncertain if these
 translate clinically into better success of creating the fistula. The aim of this study is
 therefore to compare the clinical success of the two techniques.
The micro-vascular anastamosis required for creation of a radio-cephalic arteriovenous
 fistula, is technically challenging surgery. Primary patency rates for radiocephalic fistula
 varying between 50-75% in the literature and 60-95% within over own department. It is
 important to optimise primary patency rates as initial failure subjects the patient to risks
 of further surgery and often necessiates them commencing dialysis via a tunnelled line (which
 is less effective and associated with increased risks of infection) whilst a second attempt
 at creating a fistula is undertaken.

 Multiple variations of both continuous and interrupted suture technique are described in the
 vascular literature, both in animal models of arterio-venous fistulae and in clinical studies
 in other specialities. However no study has compared the two techniques within clinical
 practice.

 Evidence from in vivo animal studies is variable. Several authors have shown no difference in
 primary patency rates achieved with continuous suture versus interrupted suture technique
 used for anastomosis(Chen & Chen, 2001; Wilasrusmee et al 2007). Others have suggested that
 using a continuous suture causes a reduced cross-sectional area of the anastomosis compared
 to an interrupted technique (Tozzi & Hayoz, 2001). Similarly an interrupted suture technique
 permits expansion of the vessel at physiological pressures where as continuous technique does
 not (Norbert & Philip, 1996; Gerdisch & Hinkamp, 2003). This loss of compliance at the
 anastomosis can in turn lead to intimal hyperplasia, causing poor blood flow and failure of
 the anastamosis (Dorbin, 1994), indicating potential theoretical benefits of interrupted
 suturing.

 There are no clinical studies comparing the two techniques and variation in practice varies
 considerably. The aim of this study therefore is the compare patency rates in radiocephalic
 fistulae by randomising to one or other anastomotic technique.
Inclusion Criteria:

 -  End stage renal failure

 -  Undergoing surgery for creation of a radiocephalic fistula

 Exclusion Criteria:

 -  Declines participation

 -  Unable to speak English or provide informed consent

 -  Radial artery diameter <1.8mm

 -  Cephalic wrist diameter at wrist <2mm