The radiocephalic
fistula dates back to the 1960s with good long-term survival and a low incidence of complications. The standard practice of creating an end cephalic vein to side radial artery
fistula (ETS) has a high incidence of early
thrombosis and failure to mature, which limits its efficacy. The hypothesis is that a 1.3- to 1.5-cm side-to-side with distal vein
ligation anastomosis (STS) is associated with a lower early
thrombosis rate and higher primary patency rate. We retrospectively evaluated all radiocephalic
fistulas created at our hospital from January 1, 2012, to December 31, 2012, comparing a 1.3- to 1.5-cm STS anastomosis to the ETS anastomosis. Primary endpoints were patency at three and six months and the secondary outcome was suitability for cannulation. An ETS anastomosis resulted in an early
thrombosis rate, 3-month cannulation rate, and 6-month primary patency rate of 14, 30, and 48 per cent, respectively. Outcomes from the STS technique were significantly improved with no early
thrombosis (P < 0.05), 3-month cannulation rate of 67 per cent (P < 0.03), and a primary patency of 75 per cent (P = 0.03). A STS radiocephalic
fistula with distal vein
ligation is superior to the ETS radiocephalic
fistula. Early
thrombosis, 6-month primary patency, and cannulation rates were significantly improved.