title: Effectiveness of surgical banding for high flow in brachial artery-based hemodialysis vascular access.
abstract: OBJECTIVE
  Autogenous arteriovenous hemodialysis (HD) access may develop high flow (>2 L/min) over time. Reducing flow volume of a high-flow access (HFA) using a surgical banding technique has been reported to be successful in the short-term. The aim of this study was to evaluate the efficacy of banding in HFAs in terms of freedom from recurrence of high flow during a 1-year follow-up.
  
  
  METHODS
  All HD patients undergoing surgical banding of an HFA during an 8-year period in three hospitals were retrospectively studied. Access flow data, freedom of recurrent high flow, and complications were analyzed during a 12-month postoperative observation period.
  
  
  RESULTS
  A total of 50 patients (30 males; age, 51 ± 2 years) were available for analysis. Banding was performed 30 ± 6 months after arteriovenous access construction. Most of the HFA patients (56%) required medication for hypertension, but diabetes mellitus and peripheral arterial obstructive disease were seldom observed (6% and 12%, respectively). Most HFAs (96%) were brachial artery-based fistulas (brachiocephalic: 56%, basilic vein transposition: 40%, radiocephalic: 4%). Banding initially reduced access flow by >50% (3070 ± 95 vs 1490 ± 105 mL/min, P < .001). Recurrent high flow (>2 L/min) developed in 52% of the patients during the observation period. Young age (45 ± 3 vs 57 ± 3 years; P = .02) and an access flow >1 L/min immediately after banding (P = .03) were risk factors for recurrent high flow.
  
  
  CONCLUSIONS
  An immediate postbanding access flow >1 L/min and young age are risk factors for recurrent high flow in a banded brachial artery-based HD access during a 1-year follow-up.
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. Electronic address: r.vaes@mmc.nl.
authors.forename: Roel H D
authors.initials: RH
authors.lastname: Vaes
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Rosanne
authors.initials: R
authors.lastname: Wouda
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Magda
authors.initials: M
authors.lastname: van Loon
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van Hoek
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Carim Research School, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Tordoir
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands; Carim Research School, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Scheltinga
mesh_terms: D000328:Adult; D000367:Age Factors; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome