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Kidney Week

Abstract: TH-PO353

Excessively High Fistula Flows in Hemodialysis Patients Possibly Result in an Irreversible Loss of Arterial Remodelling Capacity

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Gerrickens, Michael, Maxima MC, Veldhoven, Netherlands
  • Vaes, Roel Henk dorine, St Vincent's Hospital Melbourne, Richmond, New South Wales, Australia
  • Wiersma-van Rijn, Vivi, Maxima MC, Veldhoven, Netherlands
  • Van kuijk, Sander, Maastricht University Medical Centre, Maastricht, Netherlands
  • Snoeijs, Maarten G., Maastricht University Medical Centre, Maastricht, Netherlands
  • Govaert, Bas, Maxima MC, Veldhoven, Netherlands
  • Scheltinga, Marc, Maxima MC, Veldhoven, Netherlands
Background

Longstanding high flows in hemodialysis access (high flow access, HFA, >2L/min) likely harm hemodialysis patients due to cardiac overload. Flow reduction is advised, especially if hemodialysis access-induced distal ischemia (HAIDI) is also present. Revision using distal inflow (RUDI) effectively reduces flow but high flows often recur. We hypothesized that RUDI would result in shrinking of the brachial artery and dilatation of both the radial artery and greater saphenous (GSV) interponate.

Methods

HFA-patients with a brachial-artery based arteriovenous fistula with high flows (>2L/min) who underwent RUDI between 2011 and 2016 in two Dutch hospitals underwent serial Duplex sonography prior to and 2 and 12 months following RUDI. Volume flow (L/min), diameter (mm) and peak systolic velocity (PSV, cm/s) of the brachial artery, radial artery and GSV were measured. HFA-patients were grouped according to concomitant presence of hand ischemia (HFA-HAIDI), or absence (HFA).

Results

Fifteen patients (54 yr ±16, 10 males; HFA-HAIDI, n=6; HFA, n=9) with a brachial artery HFA undergoing RUDI were studied. Despite an initial decrease in brachial arterial flow followed by a slight increase (preoperative 2.7L/min ±0.3; two months 1.2L/min ±0.2; twelve months 1.5L/min ±0.2; p<.001), brachial artery diameters remained unchanged (7.4mm ±0.5). Proximal radial artery diameters doubled (overall 2.6mm ±.2 to 5.4mm ±1.0, p<.001), albeit less prominent in the HFA-HAIDI-group (+80%) than in the HFA-group (+130%, p=.019). Neither dilatation nor aneurysmatic degeneration were found in the GSV-interponate.

Conclusion

Revision using distal inflow (RUDI) for high flow access (HFA) reduction does not reverse brachial artery dilatation suggesting irreversible structural arterial wall damage possibly contributing to recurrent high flow. Radial artery remodelling is attenuated in HFA-patients previously reporting concurrent hand ischemia, diminishing the likelihood of high flow recurrence in this subgroup. The greater saphenous vein does not dilate within one year following RUDI.