TECHNIQUE OF CIRCULAR NARROWING WITH A POLYTETRAFLUOROETHYLENE GRAFT IN PATIENTS WITH HIGH-FLOW ARTERIOVENOUS FISTULA: MID-TERM RESULTS

DENIZ DEMIR¹, ALI TOSUN², NAIL KAHRAMAN¹, KADIR KAAN ÖZSIN¹, UMUT SERHAT SANRI¹, AYDEMIR KOÇASLAN³, UFUK TURAN KORKMAZ⁴, MEHMET TUĞRUL GÖNCܹ

¹Bursa Yüksek İhtisas Training and Research Hospital Cardiovasculary Surgery, Department, Surgeon¹, Bursa, Turkey - ²Şanliurfa Mehmet Akif İnan State Hospital Radiology Department, Radiologist ², Şanliurfa, Turkey - ³Harran University Cardiovasculary Surgery Department, Surgeon³, Şanliurfa, Turkey - 4Abant İzzet Baysal University Cardiovasculary Surgery Department, Surgeon ⁴, Bolu,Turkey

Introduction: An arteriovenous fistula with a high-flow rate adversely affects the hemodialysis treatment of the patients. There are several methods that help to decrease the high-flow rate. This study aims to investigate the effects of circular narrowing techni- que on lowering the flow rate with a polytetrafluoroethylene graft for the treatment of patients with a high-flow arteriovenous fistula and to present our shortand mid-term results.

Materials and methods: Seven patients with a fistula flow rate of above 1200 ml/min were retrospectively analyzed. All patients were operated on under local anesthesia and underwent a circular narrowing procedure with a polytetrafluoroethylene graft. Additional aneurysmectomy was performed on the patients with aneurysms. Fistula flow rates were recorded at baseline and following the procedure.

Results: Postoperative thrill was observed in all patients. The mean preoperative flow rate of arteriovenous fistula was 1428±230 ml/min. At three to six months following the procedure, it was 655±98 ml/min. Two patients suffered from pain in the arm at rest preoperatively and the pain resolved postoperatively. All patients continued to receive hemodialysis through the native fistula on a regular basis in the postoperative period.

Conclusion: Our study results suggest that the circular narrowing technique with a polytetrafluoroethylene graft is an effective modality that can be easily used in patients with high-flow arteriovenous fistulas.