Three Year Patency and Recurrence Rates of Revision Using Distal Inflow with a Venous Interposition Graft for High...

Area of Science:

• Vascular Surgery
• Interventional Nephrology
• Dialysis Access Management

Background:

• High flow in upper arm arteriovenous fistulas (AVF) can complicate dialysis access.
• Revision using distal inflow (RUDI) is a technique to reduce high flow accesses (HFA) and treat hemodialysis access induced distal ischemia (HAIDI).
• Long-term efficacy of RUDI for HFA, with or without HAIDI, requires further investigation.

Purpose of the Study:

• To evaluate the 3-year patency and recurrence rates of RUDI in patients with HFA, with or without concurrent HAIDI.
• To identify factors associated with recurrence of high flow after RUDI.
• To assess the long-term outcomes of RUDI in managing complex AVF complications.

Main Methods:

• Retrospective cohort study of 21 patients undergoing RUDI with greater saphenous vein (GSV) interposition for HFA (flow > 2 L/min) between 2011 and 2017.
• Patients were categorized into uncomplicated HFA or HFA with HAIDI groups.
• Data on post-operative flows, patency, and re-interventions were collected and analyzed over a 3-year follow-up period.

Main Results:

• RUDI significantly reduced access flow immediately post-operatively (3120 mL/min to 1170 mL/min).
• Overall 3-year primary patency was 48% (55% for HFA, 29% for HAIDI/HFA).
• High immediate post-operative flow and younger patient age were associated with recurrent high flow (p=0.044 and p=0.055, respectively).

Conclusions:

• RUDI with GSV interposition provides acceptable 3-year patency for HFA but often necessitates re-interventions.
• Recurrence of high flow is linked to elevated immediate post-operative flows and younger patient age.
• RUDI is a viable option for managing HFA and HAIDI, though long-term surveillance and potential re-interventions are crucial.