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Abstract: SA-PO955

Lower Access Flow After Banding Reduces Frequency of Interventions and Increases Access Patency

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Toegel, Florian, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McGlynn, Patrick, Brigham and Women's Hospital , Boston, Massachusetts, United States
  • Voiculescu, Adina Simona, Brigham and Womens Hospital, Boston, Massachusetts, United States
  • Hentschel, Dirk M., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Patency of brachial-cephalic autogenous accesses is mainly limited by cephalic arch stenosis (CAS). Shear stress is one factor believed to contribute to recurrence and high flow may be associated with less favorable shear stress. Angioplasty (PTA) is effective in the short term but complicated by high recurrence rates and stent grafts have been used to prolong patency. We report the long-term outcome after CAS PTA and stent graft placement in relation to access flow reduction.

Methods

The Brigham Health Interventional Nephrology dataset was reviewed for all patients with angioplasty and stent graft placement in patients with brachial-cephalic fistula 2008-2018, including only those patients with CAS interventions prior to the banding procedure. We used this dataset to compare the frequency of patients requiring cephalic arch angioplasty or stenting in a subset without banding procedure (control), and those with a banding procedure (exposure) to reduce the inflow segment to 3-5 mm diameter. We compared the frequency of interventions using Wilcoxon matched pair signed rank test given the non-parametric distribution of frequency of interventions.

Results

22 patients meeting inclusion criteria were included in the study. We observed a flow reduction from 1807 ± 477 pre- to 1300 ± 454 post- banding; p<0.001. Along with the flow reduction we observed an increased intervention free period from 229 (IQR: 129-320) pre- to 432 (IQR: 232-717) post-banding; p=0.02. We did not appreciate an association between the absolute flow value and number of days per procedure.

Conclusion

High blood flow is common in brachial-cephalic autogenous accesses and banding significantly decreases access flows. This access flow reduction increases the days between procedures for CAS suggesting a protective role for the development of restenosis.