Beyond Conventional: A Systematic Review of Non-Conventional Techniques for Radio-Cephalic Arteriovenous Fistula

Radio-cephalic arteriovenous fistulas (RC-AVFs), the preferred vascular access for hemodialysis, have high failure rates. New techniques like the no-touch technique (NTT) and modified no-touch technique (MNTT) have shown promising results. Our objective is to highlight the effectiveness of nonconventional techniques, aiming to address the challenge of arteriovenous fistula (AVF) failure.

We searched Medline, Google Scholar, and Clinicaltrials.gov until April 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five relevant articles were found, all involving human studies on NTT or MNTT for RC-AVF creation. We focused on primary and secondary patency rates, fistula maturation rates, and complications.

We reviewed 5 studies as follows: 2 were pilot studies, 2 were prospective studies, and one was retrospective study. Three used NTT, and 2 used MNTT. Among double-arm studies, 3 out of 4 showed a significantly improved primary patency with nonconventional techniques. However, one study found no significant difference between nonconventional and conventional methods (90.5% vs. 84.2%; P = 0.225). In a single-arm study, nonconventional technique (NTT) displayed 54% primary patency at 1 year. Secondary patency rates were in 3 studies. One demonstrated significant secondary patency with nonconventional methods compared to conventional (90% vs. 67.5%; P = 0.028), while another found no significant difference (90.5% vs. 84.2%; P = 0.803). In the single-arm study, the nonconventional technique (NTT) revealed 80% secondary patency at 1 year.

Nonconventional techniques (NTT and MNTT) show promise in improving patency rates, hinting at their potential as alternatives to the conventional technique for RC-AVF creation. Further studies are crucial to confirm their effectiveness and evaluate long-term outcomes.