Banding a hemodialysis arteriovenous fistula to decrease blood flow and resolve high output cardiac failure: report...

We report herein the successful surgical treatment of a patient with high-output cardiac failure which developed from a high-flow hemodialysis arteriovenous fistula of the Brescia-Cimino type. Banding correction of the venous limb of the fistula with a woven Dacron prosthesis resulted in marked improvement of the cardiac failure. An ultrasonic study showed the fistula flow of 3.2 l/min to be as high as 40% of the resting cardiac output, or 8.0 l/min, before banding, while an intraoperative electromagnetic study was useful for controlling the degree of banding and showing the decrease of fistula flow from 3.7 l/min to 1.4 l/min.