Key result
Surgical flow reduction improves heart failure in high-flow arteriovenous fistulas, achieving flows of ~1500 mL/min.
Why the study?
Do surgical flow reduction techniques improve clinical symptoms and reduce flow rate in patients with high flow arteriovenous fistulas?
Case Report (n=3)
Do surgical flow reduction techniques improve clinical symptoms and reduce flow rate in patients with high flow arteriovenous fistulas?
Answers are grounded in this paper and cite their sources.
Surgical flow reduction techniques can effectively improve heart failure symptoms and reduce flow rates in hemodialysis patients with high-flow arteriovenous fistulas.
BACKGROUND: The development of a high flow rate arteriovenous fistula (AVF) can expose the patient to development of heart failure due to increased cardiac preload and pulmonary hypertension. OBJECTIVES: AVF flow measurement (Qa) is considered a screening tool for AVF surveillance, aiming to evaluate the access dysfunction and prevent complications, like a non-maturation, suspected stenosis, high-flow AVF, and distal ischemia. In the upper arm AVF, a high Qa may develops, which can expose the patient to the risk of high-output heart failure and ischemia. Although, the exact threshold to define high-flow access is not universally accepted, AVF with a Qa of 1-1.5 L/min or cardio-pulmonary recirculation (Qa/CO) >20% are considered at risk. SUBJECTS: In our work we describe the treatment performed in three patients with high flow AVF treated with DRIL technique with interposition of a Prosthetic Patch, revascularization procedures such as distal inflow revision or RUDI and with innovative technique a "tench snout," removal the previous anastomosis and reconstruction of the integrity of the radial artery at the terminal in pre and post anastomosis. A PTFE prosthetic segment measuring 5 cm in length and 5 mm in diameter was interposed, terminally anastomosed with the efferent cephalic vein and terminally lateral with the radial artery, reducing the anastomosis to approximately 4 mm. RESULTS: All treated patients showed a clear improvement in the clinical picture in particularly heart failure. The calculation of the post-intervention flow rate approximately 1500 mL/min. CONCLUSION: The patient on hemodialysis with arteriovenous fistula must be constantly monitored with clinical examination, monitoring during the hemodialysis session and color Doppler ultrasound of the AVF with calculation of the flow rate. The surgical technique used for flow reduction is chosen on the surgical experience of each operator with the main objective of preserving the autologous AVF.
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Cristiano et al. (2024) conducted a case report in High flow arteriovenous fistula (n=3). Surgical flow reduction techniques (DRIL, RUDI, tench snout) was evaluated on Clinical improvement and post-intervention flow rate. Surgical flow reduction techniques in three patients with high flow arteriovenous fistulas resulted in clear clinical improvement of heart failure and a post-intervention flow rate of approximately 1500 mL/min.
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