title: Access flow reduction for cardiac failure.
abstract: High-flow in hemodialysis arteriovenous angioaccesses is frequent. It may result in high-output cardiac failure, which should be prevented by fistula flow reduction. The most frequently reported flow reduction procedure is banding but immediate and long-term results are questionable. Alternative techniques are related here with personal results. Juxta-anastomosis "Proximal Radial Artery Ligation" (PRAL) is a very simple and effective reduction technique for side-to-end radio-cephalic fistulas (82 patients; reduction rate [RR]: 54% ± 19%). For brachial artery-based fistulas flow reduction two variants of Revision Using Distal Inflow (RUDI) procedures are used: 1) RUDI-1 using a polytetrafluoroethylene (PTFE) graft or a greater saphenous vein, which we first described in 1989 as "Distal Report of the Arterial Inflow" (35 patients; RR: 53% ± 18%), 2) RUDI-2 procedure, "Transposition of the Radial Artery", which we described in 2009 (47 patients; RR: 66% ± 14%).
authors.affiliation: Angioaccess Surgery Department, Clinique Jouvenet, Paris - France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourquelot
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation; D016534:Cardiac Output, High / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008026:Ligation; D017534:Radial Artery / Q000601:surgery; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*