The Results of The Interposition Graft-Technique in Treatment of High Flow Vascular Access

Objective: High-flow (HF) vascular access (VA) is a fearsome condition potentially responsible for cardiac or pulmonary complications, steal syndrome and hand ischemia. The present study was conducted to report the results achieved in a group of patients undergoing interposition-graft technique to treat HF. Materials and methods: An analysis of clinical, ultrasound and echocardiography data collected from the review of medical charts was performed. Flow reduction, complications and need for secondary interventions were investigated. Results: Among a total 498 hemodialysis access interventions performed during a 6-years period, 30 patients (n 15, 50% male, median age 63.5, range 42-91 years) presented with high-flow (median flow 1.9 L/min, range 1.5-4 L/min). 18 patients were asymptomatic (60%); 6 (20%) suffered from a severe distal hand ischemia; 5 (16.6%) developed signs of congestive heart failure and 1 patient (3.3%) presented with pulmonary hypertension. In twenty patients (66.7%) the access was preserved by the interposition of a 6 mm polytetrafluroethylene (PTFE) prosthesis. This approach was used as a primary flow reduction technique in 16 patients (80%) or the failure of a previously attempted procedure in 4 cases. No intraoperative complications were observed. Post-operative median VA flow was 1.1 L/min (range 0.900-2 L/min), with a median flow reduction of 0.770 L/min (range 0.100-2.8 L/min). At a median follow-up of 9 months (range 1-42), 95% (n 19) of patients were free from recurrences. Conclusion: In treatment of HF-VA graft interposition demonstrated satisfactory results at the mid-term follow-up. More data are needed to affirm this technique as the preferential one.