One-year efficacy of the RUDI technique for flow reduction in high-flow autologous brachial artery-based hemodialysis vascular access.
OBJECTIVE
Flow reduction is advised in hemodialysis (HD) patients with a high-flow (>2 L/min) arteriovenous fistula (AVF). The revision using distal inflow (RUDI) technique is based on the premise that access flow is attenuated once inflow is provided by a smaller caliber forearm artery. Aim of the study was to evaluate the efficacy of RUDI during a 1-year follow-up.


METHODS
All HD patients undergoing a RUDI operation using a greater saphenous vein (GSV) or a basilic vein (BaV) interposition for a high-flow access (HFA, >2 L/min) during a 3.5-year time period were included. Serial access flow, percentage of freedom from recurrent high flow and complications were determined.


RESULTS
A total of 19 HFA patients were studied (11 males, age 55 ± 3 years). All AVFs were brachial artery based (brachiocephalic, n = 14; brachiobasilic, n = 5). RUDI immediately reduced access flow by almost 2 L/min (3,080 ± 200 to 1,170 ± 160 mL/min (p = 0.001)). Access flows at 1, 6 and 12 months were 1,150 ± 160, 1,460 ± 200 and 1,580 ± 260 mL/min, respectively. Postoperative complications included insufficient flow reduction (n = 1, BaV) and occlusion requiring revision (n = 1, GSV). Recurrent HFA occurred three times (n = 2 BaV, n = 1 GSV). Access flows were significantly (p<0.05) higher in the BaV group compared to the GSV group.


CONCLUSIONS
RUDI effectively reduces access flow in a brachial artery-based high-flow HD vascular access. A flow-reducing effect is sustained at 1-year follow-up in most patients. GSV is preferred as an interposition graft compared to a BaV.
1 Department of Surgery, Máxima Medical Center, Veldhoven - The Netherlands.
Roel H D
RH
Vaes
Magda
M
van Loon
Selma M M
SM
Vaes
Philippe
P
Cuypers
Jan H
JH
Tordoir
Marc R
MR
Scheltinga
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; 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 / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012501:Saphenous Vein / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*