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Published on: November 11, 2012
The Results of The Interposition Graft-Technique in Treatment of High Flow Vascular Access
Ottavia Borghese1, Angelo Pisani2, Isabelle Di Centa3
1Department of Vascular Surgery, Foch Hospital, Suresnes, France.; PhD school in angio-cardio-thoracic pathophysiology and imaging, Sapienza University, Rome, Italy.
Insights
Interposition graft technique effectively treats high-flow (HF) vascular access (VA) complications like ischemia and heart failure. This method preserved access in most patients with satisfactory mid-term results, reducing flow and preventing recurrence.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- High-flow (HF) vascular access (VA) can lead to serious complications including cardiac issues, steal syndrome, and hand ischemia.
- Effective management strategies for HF-VA are crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of the interposition-graft technique in treating patients with high-flow vascular access.
- To assess complication rates and the need for secondary interventions after this procedure.
Main Methods:
- Retrospective analysis of clinical, ultrasound, and echocardiography data from 30 patients with HF-VA.
- Interposition of a polytetrafluoroethylene (PTFE) graft used for flow reduction.
Main Results:
- Among 30 patients with HF-VA, 60% were asymptomatic, while others experienced hand ischemia, heart failure, or pulmonary hypertension.
- The interposition-graft technique preserved access in 66.7% of patients, with a median flow reduction from 1.9 L/min to 1.1 L/min.
- At a median 9-month follow-up, 95% of patients were free from recurrence, with no intraoperative complications.
Conclusions:
- Interposition-graft technique shows satisfactory mid-term results for treating high-flow vascular access.
- Further research is needed to establish this technique as a preferred treatment option.
Objective:
High-flow (HF) vascular access (VA) is a fearsome condition potentially responsible for cardiac or pulmonary complications, steal syndrome and hand ischemia. The present study was conducted to report the results achieved in a group of patients undergoing interposition-graft technique to treat HF.
Materials And Methods:
An analysis of clinical, ultrasound and echocardiography data collected from the review of medical charts was performed. Flow reduction, complications and need for secondary interventions were investigated.
Results:
Among a total 498 hemodialysis access interventions performed during a 6-years period, 30 patients (n 15, 50% male, median age 63.5, range 42-91 years) presented with high-flow (median flow 1.9 L/min, range 1.5-4 L/min). 18 patients were asymptomatic (60%); 6 (20%) suffered from a severe distal hand ischemia; 5 (16.6%) developed signs of congestive heart failure and 1 patient (3.3%) presented with pulmonary hypertension. In twenty patients (66.7%) the access was preserved by the interposition of a 6 mm polytetrafluroethylene (PTFE) prosthesis. This approach was used as a primary flow reduction technique in 16 patients (80%) or the failure of a previously attempted procedure in 4 cases. No intraoperative complications were observed. Post-operative median VA flow was 1.1 L/min (range 0.900-2 L/min), with a median flow reduction of 0.770 L/min (range 0.100-2.8 L/min). At a median follow-up of 9 months (range 1-42), 95% (n 19) of patients were free from recurrences.
Conclusion:
In treatment of HF-VA graft interposition demonstrated satisfactory results at the mid-term follow-up. More data are needed to affirm this technique as the preferential one.
