External dilator-assisted banding for high-flow hemodialysis arteriovenous fistula

Abstract

Creation of arteriovenous fistula (AVF) may lead to left ventricle hypertrophy and predispose for development or worsening of heart failure. It was postulated to reduce access blood flow if exceeded 2 L/min or cardiac index was higher than 3.0 L/min/m2. Numbers of techniques decreasing flow were described. The major disadvantage was the complexity of procedure and necessity of intraoperative flow measurement needed to establish desired flow. The technique of dilator-assisted banding with no endovascular catheterization is presented. After blunt dissection non absorbable thread was placed around vessel and tied over the dilator. Then the dilator was gently removed and blood flow was confirmed by palpation. We performed 12 banding procedures. Mean brachial blood flows were 3733.2 ± 826.2 mL/min preoperatively and 1461.2 ± 337.7 mL/min after surgery. Mean flow reduction was 2272.2 ± 726.9 mL/min. The external dilator-assisted banding is a feasible method for vascular access flow reduction without necessity of endovascular catheterization.