Annals of Vascular Diseases
Online ISSN : 1881-6428
Print ISSN : 1881-641X
ISSN-L : 1881-641X
ORIGINAL ARTICLES
Graft Inclusion Technique: A New Flow Reduction Procedure for High Flow Arteriovenous Fistulae
Takehisa Nojima Yasuki Motomiya
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JOURNAL OPEN ACCESS

2018 Volume 11 Issue 2 Pages 202-209

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Abstract

Objective: Flow reduction is required to preserve vascular access in cases with high flow access (HFA). We report a new flow reduction procedure, the graft inclusion technique (GIT).

Methods: The GIT procedure developed by us involves the intraluminal placement and suturing of a 4-mm polytetrafluoroethylene graft to the anastomosis and outflow tract to plicate the enlarged anastomosis and maintain lower flow volumes. Flow reduction for HFA was retrospectively assessed in a series of 25 patients (age 65±12 years; 17 males and 8 females) to evaluate flow volume and patency rate, wherein 10 patients underwent conventional methods of flow reduction and 15 underwent GIT.

Results: Compared with preprocedure values, mean flow volume (MFV) was significantly lower after the procedure with both the conventional methods (1,817 vs. 586 ml/min; P<0.05) and the GIT (2,262 vs. 890 ml/min; P<0.05). An increase in MFV occurred during follow-up after conventional flow reduction (586 vs. 1,036 ml/min), while GIT could maintain lower MFV (890 vs. 791 ml/min), suggesting that GIT can significantly lower MFV levels (2,262 vs. 791 ml/min; P<0.05) and maintain these lower MFV levels during follow-up. Secondary patency rate for the GIT was 100% at 1 year and 83% at 3 years.

Conclusion: The GIT may be used as an access-preserving, reliable, long-term, and stable flow-reducing procedure that does not require flow adjustment during surgery.

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© 2018 The Editorial Committee of Annals of Vascular Diseases. This article is distributed under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided the credit of the original work, a link to the license, and indication of any change are properly given, and the original work is not used for commercial purposes. Remixed or transformed contributions must be distributed under the same license as the original.

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