Effectiveness of surgical banding for high flow in brachial artery-based hemodialysis vascular access.

OBJECTIVE: Autogenous arteriovenous hemodialysis (HD) access may develop high flow (>2 L/min) over time. Reducing flow volume of a high-flow access (HFA) using a surgical banding technique has been reported to be successful in the short-term. The aim of this study was to evaluate the efficacy of banding in HFAs in terms of freedom from recurrence of high flow during a 1-year follow-up.

METHODS: All HD patients undergoing surgical banding of an HFA during an 8-year period in three hospitals were retrospectively studied. Access flow data, freedom of recurrent high flow, and complications were analyzed during a 12-month postoperative observation period.

RESULTS: A total of 50 patients (30 males; age, 51 ± 2 years) were available for analysis. Banding was performed 30 ± 6 months after arteriovenous access construction. Most of the HFA patients (56%) required medication for hypertension, but diabetes mellitus and peripheral arterial obstructive disease were seldom observed (6% and 12%, respectively). Most HFAs (96%) were brachial artery-based fistulas (brachiocephalic: 56%, basilic vein transposition: 40%, radiocephalic: 4%). Banding initially reduced access flow by >50% (3070 ± 95 vs 1490 ± 105 mL/min, P < .001). Recurrent high flow (>2 L/min) developed in 52% of the patients during the observation period. Young age (45 ± 3 vs 57 ± 3 years; P = .02) and an access flow >1 L/min immediately after banding (P = .03) were risk factors for recurrent high flow.

CONCLUSIONS: An immediate postbanding access flow >1 L/min and young age are risk factors for recurrent high flow in a banded brachial artery-based HD access during a 1-year follow-up.