A percutaneous endovascular technique for reducing arteriovenous fistula flow

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Endovascular Techniques

Background:

• High flow in arteriovenous fistulas (AVFs) can compromise access longevity and patient outcomes.
• Traditional methods for reducing AVF flow often involve open surgical revision, which carries higher risks and longer recovery times.
• A minimally invasive endovascular approach is needed for precise and effective management of excessive AVF flow.

Observation:

• A novel endovascular procedure was developed using a two-stent technique to create a constrained lumen.
• A small stent was deployed near the anastomosis, followed by a larger stent placed inside the first, forming a corset-like constriction.
• This technique was successfully applied in three patients with excessive AVF flow.

Findings:

• The constrained stent-graft placement precisely narrowed the inflow lumen to a 5 mm diameter.
• Estimated access flow was significantly reduced, decreasing from initial values of 1900, 1600, and 1500 mL/min to 1100, 900, and 900 mL/min, respectively.
• The endovascular procedure effectively reduced excessive arteriovenous access flow with a minimally invasive approach.

Implications:

• Percutaneous endovascular placement of a constrained stent-graft offers a precise and effective alternative to open surgery for reducing AVF flow.
• This technique allows for long-term control of access flow, potentially improving the durability and function of hemodialysis access.
• The described method provides a valuable new option for managing high-flow arteriovenous fistulas in patients requiring hemodialysis.