title: Vascular access flow reduction for arteriovenous fistula salvage in symptomatic patients with central venous occlusion.
abstract: OBJECTIVE
  Vascular access patients with central vein (CV) stenosis or occlusion may have significant symptoms. Treatment is generally by balloon angioplasty, with or without stenting. However, CV lesions may not be correctable and when treated, tend to recur. Surgical bypass of CV obstruction is a major procedure and ligation of the access may leave the patient dependent on catheter dialysis. We review a precision inflow banding procedure to limit vascular access flow and pressure for symptomatic patients with CV obstruction while preserving access functionality.
  
  
  METHODS
  All individuals with symptomatic CV occlusive disease who underwent an autogenous vascular access inflow restriction procedure by the two senior authors were identified. All had failed attempts to correct CV lesions by angioplasty and stent placement. A precision banding procedure was used for access inflow reduction with the addition of real-time intravascular flow monitoring.
  
  
  RESULTS
  Twenty-two patients were identified. Ages were 22-72 years (mean=43 years). Nine patients (40.9%) were women, and 8 (36.4%) obese. Mean access flow was 1640 mL/minute before banding decreased to 820 mL/minute after banding (P< .01). All patients had access salvage. Swelling resolved promptly in 20 patients and was markedly improved in two individuals. Three patients underwent aneurysm repair with simultaneous inflow banding and decreased intra-access pressure after flow restriction. Two fistulas failed at eight and 13 months. Mean follow-up was 8 months.
  
  
  CONCLUSIONS
  The symptoms of hemodialysis vascular access patients associated with non-correctable central venous lesions resolved successfully and their access was maintained using a precision inflow banding procedure.
authors: Department of Surgery, College of Medicine, University of Oklahoma-Tulsa, Tulsa, OK 74135, USA. William-Jennings@ouhsc.edu
authors: William C
authors: WC
authors: Jennings
authors: Gregg A
authors: GA
authors: Miller
authors: M Zachary
authors: MZ
authors: Coburn
authors: C Anthony
authors: CA
authors: Howard
authors: Michael A
authors: MA
authors: Lawless
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009519:New York City; D009825:Oklahoma; D012039:Regional Blood Flow; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency; D055815:Young Adult