Flow reduction surgery using graft inclusion technique for high-flow arteriovenous fistula: a description of techniques and clinical efficacy

Objectives: To evaluate the initial hemodynamic efficacy and clinical safety of flow reduction surgery using the graft inclusion technique in chronic kidney disease patients with symptomatic high-flow arteriovenous fistulas. Methods: A retrospective, cross-sectional descriptive study was conducted on 5 chronic kidney disease patients with symptomatic high-flow arteriovenous fistulas who underwent flow reduction surgery using the graft inclusion technique at Thu Duc General Hospital. Inclusion criteria included an access blood flow (Qa) > 2000 ml/min and clinical manifestations of heart failure (NYHA II-IV) or hemodialysis access-induced distal ischemia. Results: The mean age of the patients was 56.4 ± 6.2 years (3 males, 2 females). The mean preoperative Qa was extremely high at 3168.2 ± 1360.9 ml/min. At 1 week and 3 months post-operation, the flow decreased to 1665.8 ± 589.7 and 1671.4 ± 610.8 ml/min, respectively (achieving an average reduction of 47.2%). 100% of the patients recovered well, showing improvement in NYHA classification and complete resolution of rest pain. The access patency rate was 5/5, and patients were able to undergo hemodialysis immediately after surgery. Conclusions: Flow reduction surgery using the graft inclusion technique is a breakthrough solution that overcomes the limitations of traditional methods. This technique helps maintain long-term stable flow and significantly improves both cardiovascular and local complications.