Taro Kanno1,2, Yuji Kamijo1, Koji Hashimoto1, Yutaka Kanno2. 1. Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Nagano - Japan. 2. Department of Nephrology, Kanno Dialysis and Vascular Access Clinic, Matsumoto, Nagano - Japan.
Abstract
PURPOSE: 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.
PURPOSE: 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.
Authors: Spyros I Papadoulas; Natasa Kouri; Andreas Tsimpoukis; Panagiotis Kitrou; Marios Papasotiriou; Konstantinos M Nikolakopoulos; Georgios-Ioannis Verras; Ioannis Panagiotopoulos; Francesk Mulita; Konstantinos G Moulakakis Journal: Kardiochir Torakochirurgia Pol Date: 2022-10-08