P-055 - NITINOL EXTERNAL SUPPORT FOR HIGH FLOW FISTULA: LONG TERM EFFICACY

TOPIC:
Vascular Access
AUTHORS:
Muscato P. (Università degli studi dell'Insubria ~ Varese ~ Italy) , Goddi A. (Centro Medico SME-Diagnostica per Immagini, Varese - Italy ~ Varese ~ Italy) , Franchin M. (Università degli studi dell'Insubria ~ Varese ~ Italy) , Mauri F. (Università degli studi dell'Insubria ~ Varese ~ Italy) , Tozzi M. (Università degli studi dell'Insubria ~ Varese ~ Italy)
Introduction:
The aim of the present study is to report our experience in anastomosis redo with the aid of nitinol external support and evaluate the long-term efficacy of this technique in the treatment of high flow fistula and Haemodialysis access-induced distal ischemia (HAIDI).
Methods:
All consecutive patients referred to our centre for HAIDI (grade 3 and 4) from January 2021 to December 2021 were treated. We performed revision of artero-venous anastomosis for reduction of diameter (less than 5 mm); operating reduction of first 3 centimeter of vein and applicating VasQ N° 6 (Fig.1). Each patient performed a DUS control monthly for first 6 months and then bi-monthly. Haemodynamic data flow, PSV and diameter of anastomotic area were collected prospectively and compared with previous experience.
Results:
In the period under review, we treated 5 patients with high flow fistula with nitinol external support. In previous period we treated 27 patients, 22 of whom undergone surgery for standard anastomosis redo and outflow remodelling, 5 undergone surgery for AVF closure (2 patients after kidney transplantation and 3 for persistence of pain and lesions). During follow-up period (12 months) in the group of 22 patients treated with anastomosis reduction and outflow remodelling, 11 patients have manifested the recurrence of the symptomatology (stage 4a of HAIDI). Otherwise, the group of 5 patients treated with anastomosis redo with nitinol external support had no resurgence of symptoms within 12 months (p.047). Additionally to the standard Doppler-ultrasound, we studied the artero-venous anastomotic area with vector flow ultrasound method in order to examine the condition of blood flow through the anastomosis.
Conclusion:
Patients treated with nitinol external support have less recurrence of HAIDI/high flow symptoms and vector flow ultrasound imaging showed a less turbulent flow than in anastomosis reducted with standard method. The application of the nitinol external device in high flow AVF is an effective system that can be combined to surgical reduction of the anastomotic area in high flow fistula with or without symptoms of HAIDI.
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