Outcomes of blood flow suppression methods of treating high flow access in hemodialysis patients with arteriovenous fistula.
OBJECTIVE
A high flow access (HFA) may cause heart failure in patients with an arteriovenous fistula (AVF) undergoing hemodialysis (HD) and is associated with poor prognosis. There are a variety of blood flow suppression techniques for treating HFA; however, the therapeutic outcome is still unclear.


METHODS
The following three different blood flow suppression methods were performed on 74 patients with HFA: proximal artery banding with distal artery ligation (A-ban with A-lig: 12 cases); shunt vein banding (V-ban: 37 cases); and anastoplasty (Ana: 25 cases).


RESULTS
There were no differences in the sex or mean age or duration of HD between the treatment groups. The A-ban with A-lig method was mainly selected for patients with a distal AVF and the anastoplasty method was selected most often for patients with a cubital AVF. The techniques were equally effective in reducing flow volume (FV) and the FV/cardiac output ratio (Flow/CO) to target levels, and clinical symptoms improved in all patients. The rates of HFA recurrence and AVF occlusion were significantly higher in the V-ban group (18.9% and 24.3%, respectively). A small proportion of patients in each treatment group developed a postoperative infection.


CONCLUSIONS
Each method proved to be an effective means of treating HFA. The choice of surgical method should be informed by the type of vascular access; however, the A-ban with A-lig and Ana methods appear to achieve clinically significant reductions in FV and have lower rates of HFA recurrence and AVF occlusion.
Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Nagano - Japan.|Department of Nephrology, Kanno Dialysis and Vascular Access Clinic, Matsumoto, Nagano - Japan.
Taro
T
Kanno
Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Nagano - Japan.
Yuji
Y
Kamijo
Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Nagano - Japan.
Koji
K
Hashimoto
Department of Nephrology, Kanno Dialysis and Vascular Access Clinic, Matsumoto, Nagano - Japan.
Yutaka
Y
Kanno
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000503:physiopathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002302:Cardiac Output; D016534:Cardiac Output, High / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003250:Constriction; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000009:adverse effects; D012086:Reoperation; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014680:Veins / Q000503:physiopathology / Q000601:surgery*