Arterio-Venous Fistula Flow Dynamics and Results of Surgical Revision using Distal Inflow in Patients with Massive Limb Edema from Central Venous Occlusion
Kanchanabat B, MD1, Stapanavatr W, MD1
Affiliation : 1 Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Objective : To investigate the flow dynamics and outcomes of AVF flow reduction surgery using distal inflow in such patients.
Materials and Methods : A prospectively collected data on AVF flow dynamics of 19 hemodialysis patients with neck or arm edema
from central venous occlusion and the outcomes of eight flow reduction procedures between February 2011 and December 2014
were retrospectively reviewed. AVF flow rate was measured by duplex Doppler ultrasound. Flow reduction surgery was performed
in patients with high flow AVF by switching the inflow to radial or ulnar artery. Outcomes of surgery were assessed in terms of AVF
flow rate reduction and relief of edema.
Results : Of the 19 patients included, the mean age of AVFs was 5.3+3.6 years. Fifteen patients (79%) had brachial artery inflow AVF
and the remaining four patients (21%) had radial artery inflow fistula. The mean flow rates of brachial and radial artery based AVFs
were 2,191+1,367 ml/min and 1,455+560 ml/min, respectively. Eight AVF surgical revisions using distal inflow were performed
in seven patients, which resulted in a significant reduction of mean flow rate from 2,900+1,256 ml/min to 860+480 ml/min (p<0.001).
Relief of edema was achieved in 7 out of 8 instances.
Conclusion : AVF flow rate tended to be high in most of the circumstances. The surgical revision using distal inflow significantly
reduced AVF flow rate and improved limb edema. This procedure could be a viable option in high flow AVF patients.
Keywords : Arterio-venous fistula, Central venous occlusion, Edema, Limb swelling
