Doppler ultrasonography-guided surgery for high-flow hemodialysis vascular access: preliminary results

Tellioglu G, Berber I, Kilicoglu G, Seymen P, Kara M, Titiz I.

Source

Department of General Surgery and Transplantation Unit, Haydarpasa Numune Training and Research Hospital, Uskudar, Istanbul, Turkey. [email protected]

Abstract

AIM:

We sought to investigate the results of flow reduction with prospective Doppler ultrasonography (USG)-guided surgery.

PATIENTS AND METHODS:

Thirty patients with end-stage renal failure with high-flow arterio-venous (AV) fistulae (n = 25) or AV grafts (n = 5) were included in the study. The indications for operation were as follows: cardiac failure (n = 18) or steal syndrome (n = 12). AV fistula flow >800 mL/min or AV graft >1200 mL/min was the selection criterion for definition of a high-flow vascular access. The desired postoperative flow was 400 mL/min or 800 mL/min for AV fistula or AV graft, respectively. Before the surgical intervention, a vascular clamp was used to simulate the planned intervention with evaluation by Doppler USG after the anastomosis was narrowed.

RESULTS:

There were 16 men and 14 women with a median age of 48 +/- 9 years (range, 39-57 years). Preoperative measurements of median AV fistula, AV graft flow, and anastomosis diameter were as follows: 2663 mL/min (range, 1856-3440 mL/min); 2751 mL/min (range, 2140-3584 mL/min); and 7.3 mm (range, 6.1- 8.5 mm), respectively. The flow was reduced to 615 mL/min (range, 552-810 mL/min) for AV fistulae and 805 mL/min (range, 745-980 mL/min) for AV grafts. The median diameter of the anastomosis was reduced to 4 mm (range, 3.5-4.3 mm). There were no reinterventions. During the median 1-year follow-up, AV fistula and AV graft patency rates were 100% and 80%, respectively and clinical complaints resolved. Cardiac output rate was reduced from 8.5 +/- 2.9 L/min to 6.1 +/- 1.9 L/min (P < .01).

CONCLUSION:

Cardiac failure and steal syndrome resulting from high-flow vascular access can be treated successfully with Doppler USG-guided surgery. The desired anastomotic diameter and flow are limited in cases of excessively dilated efferent veins for vascular access.