Korean J Transplant.  2022 Nov;36(Supple 1):S386. 10.4285/ATW2022.F-5252.

A 2-year follow-up after banding of high output arteriovenous fistula using polytetrafluoroethylene graft

• Burog A
• Baloloy LC

• KMID: 2535218
• DOI: http://doi.org/10.4285/ATW2022.F-5252

Abstract

High blood flow within the arteriovenous fistula, although desirable, may cause vein dilatation with resultant increase in vessel capacitance leading to compensatory increased cardiac output. While asymptomatic aneurysms do not require intervention, close monitoring and prophylactic management of arteriovenous access with high flow is reasonable to avoid serious compli-cations such as cardiac failure. We described a surgical technique we utilized to address a high outflow arteriovenous fistula. The patient is a 40-year-old female, case of end stage renal disease secondary to hypoplastic kidneys, status post-kidney transplantation with failed kidney allograft. She is back to hemodialysis since 4 years ago using her left brachiocephalic ar-teriovenous fistula and presented with progressive enlargement of the left upper arm cephalic vein associated with pain and heaviness and prolonged bleeding at cannulation sites after hemodialysis. Echocardiogram revealed ventricular hypertrophy, diastolic dysfunction with elevated ventricular filling pressure. Preoperative ultrasound confirmed presence of high output fistula with flow of 9,103 mL/min. She underwent ultrasound guided banding of high output arteriovenous fistula using polytet-rafluoroethylene graft and reduction of flow to 3766ml/min was achieved. Immediately post-op, there was noted decrease in the size, thrill and bruit of the cephalic vein in the left upper arm. Two years after surgery, the patient still has a functioning ar-teriovenous fistula and improved symptoms of cardiac overload. Banding is a simple, accessible and reasonable flow-reducing surgical technique to address high-flow arteriovenous access.