Findings by an international team of researchers led by Dr. Alan Dardik of the Yale School of Medicine Department of Surgery show promise for patients with end-stage renal disease requiring hemodialysis. The research, published August 19, 2020, is the cover story for the online issue (Vol 12, Issue 557), and the lead story of the print edition.
Surgeons connect patients requiring hemodialysis to the dialysis machines using an arteriovenous fistula (AVF) when possible; although the AVF is the best type of connection compared to grafts or catheters, the AVF traditionally is associated with a limited lifespan and requires frequent procedures and revisions to maintain patency.
The research team previously showed that creating an AVF using the non-traditional Radial Artery Deviation And Reimplantation (RADAR) technique improves short-term patency of the fistula. The RADAR technique uses an artery-to-vein configuration, as opposed to the conventional vein-to-artery configuration.
This latest study shows 3-year durability of RADAR in human patients; a primary benefit of the RADAR approach is improved outcomes in both sexes, with improved AVF maturation, improved patency, and decreased numbers of reinterventions. The study also showed improved hemodynamics in a rat model, which researchers hypothesize may be responsible for the improved long-term results in humans.
“These findings are of translational importance and should influence the way surgeons create radial-cephalic fistulae for improved outcomes,” said Dr. Dardik.
The majority of conventional AVF procedures fail early on, and of the 40-50% that do provide adequate hemodialysis, only half of them remain patent at one year.
“We are excited that RADAR improves dialysis access outcomes in women, since women have worse outcomes with conventional AVF compared to men” said Dr. Nirvana Sadaghianloo, lead author.
“The rat studies show that the artery-to-vein configuration has improved hemodynamics compared to the traditional way that surgeons make fistulae,” said Dr. Jolanta Gorecka, a Yale surgery resident and co-author on the study.
The research team is an international collaboration among current and alumni members of the Dardik Lab at the Yale School of Medicine, Zhengzhou University in China, and the Universite Cote d’Azur, in Nice, France.