An ultrasound-guided no incision banding method for the treatment of arteriovenous fistula high-flow in hemodialysis

Abstract

Objective

High-flow vascular access is one of the serious complications in the maturation and subsequent use of arteriovenous fistula (AVF). We adopted a novel surgical approach named no incision limited ligation indwelling needle assisted- revision (NILLINR) to treat high-flow of the hemodialysis vascular access and ascertained the outcomes by regular follow-up visits.

Methods

This is a retrospective study. 26 hemodialysis patients with symptomatic high-flow access (access flow > 1500 mL/min) were treated with the novel banding method without incision between June 2018 and October 2020. The flow of the brachial artery before and after the restriction was measured by experienced clinicians by using the duplex Doppler ultrasound (DUS). All 26 patients were followed up for up to 1 year. Meanwhile, the brachial artery flow was recorded at 6 months and 1 year after restriction.

Results

Of all 26 patients included in this study, the mean access flow volume decreased from 2196.2 ± 416.9 mL/min (mean ± SD) to 679.2 ± 67.1 mL/min immediately after the operation. During the follow-up, the volume flow of the brachial artery was still within the restricted range at 6 months (mean ± SD, 720.2 ± 164.7 mL/min) and 1 year (mean ± SD, 713.9 ± 173.8 mL/min) after the operation. Meanwhile, the mean duration of the operation is 8.5 ± 3.3 min, and there is no bleeding or rupture.

Conclusion

This novel no-incision limited ligation indwelling needle-assisted revision is a safe, effective, and time-saving option to treat high-flow access.

Keywords:

• Arteriovenous fistula
• high-flow vascular access
• no-incision banding method
• hemodialysis

Acknowledgments

The authors thank all of our colleagues working in the Department of Nephrology, at Tongji Hospital.

Informed consent statement

Written informed consent has been obtained from the patients to publish this paper.

Author contributions

FH designed and supervised the study. FH and WL performed the operations. YW, YZ and JL collected data from patients. YW and QL analyzed the data and wrote the manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data underlying this article will be shared on reasonable request with the corresponding authors.

Additional information

Funding

This work was supported by the [National Natural Science Foundation of China] under Grant [81974089] and Grant [81800611], the [Natural Science Foundation of Hubei Province] under Grant [2019CFB675], and the [Frontier Application Basic Project of the Wuhan Science and Technology Bureau] under Grant [2020020601012235].