Enhancing Arteriovenous (AV) Fistula Banding Accuracy With Intraoperative Ultrasound: A Case Report

High-output arteriovenous fistulas (AVFs) pose a risk for volume overload, venous hypertension, and right heart strain in hemodialysis patients. We present a case of a 55-year-old male with a symptomatic high-flow brachiocephalic AVF, successfully managed with intraoperative duplex ultrasound-guided banding. Real-time flow measurements enabled precise titration of constriction, reducing flow from 7,891 to 2,000 mL/minute. Postoperative recovery was uneventful, with symptom resolution and preserved access patency. This case demonstrates the clinical utility of intraoperative duplex ultrasound in enhancing surgical accuracy and optimizing outcomes during AVF revision. Broader adoption may improve safety and standardization in managing high-output dialysis access.