Technique of circular narrowing with a polytetrafluoroethylene graft in patients with high-flow arteriovenous fistula: mid-term results

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 technique 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.