Fistula Reconstruction Surgery with Small Anastomosis for High Flow in Arteriovenous Fistula

Abstract

Large anastomosis causes often high flow in arteriovenous fistula (AVF). A 50-year-old man on hemodialysis sustained high-output heart failure. He had an AVF created in his left forearm. An echogram indicated blood flow that was 2600 mL/min in the proximal brachial artery. B-type natriuretic peptide level was 1720 pg/mL. After fistula reconstruction surgery with small anastomosis (2 mm) in his same forearm, his heart failure resolved and blood flow was 810 mL/min on three months. This method is a simple and effective intervention for high flow in AVF.