One-year efficacy of the RUDI technique for flow reduction in high-flow autologous brachial artery-based hemodialysis vascular access.

Abstract

Flow reduction is advised in hemodialysis (HD) patients with a high-flow (>2 L/min) arteriovenous fistula (AVF). The revision using distal inflow (RUDI) technique is based on the premise that access flow is attenuated once inflow is provided by a smaller caliber forearm artery. Aim of the study was to evaluate the efficacy of RUDI during a 1-year follow-up. All HD patients undergoing a RUDI operation using a greater saphenous vein (GSV) or a basilic vein (BaV) interposition for a high-flow access (HFA, >2 L/min) during a 3.5-year time period were included. Serial access flow, percentage of freedom from recurrent high flow and complications were determined. A total of 19 HFA patients were studied (11 males, age 55 ± 3 years). All AVFs were brachial artery based (brachiocephalic, n = 14; brachiobasilic, n = 5). RUDI immediately reduced access flow by almost 2 L/min (3,080 ± 200 to 1,170 ± 160 mL/min (p = 0.001)). Access flows at 1, 6 and 12 months were 1,150 ± 160, 1,460 ± 200 and 1,580 ± 260 mL/min, respectively. Postoperative complications included insufficient flow reduction (n = 1, BaV) and occlusion requiring revision (n = 1, GSV). Recurrent HFA occurred three times (n = 2 BaV, n = 1 GSV). Access flows were significantly (p<0.05) higher in the BaV group compared to the GSV group. RUDI effectively reduces access flow in a brachial artery-based high-flow HD vascular access. A flow-reducing effect is sustained at 1-year follow-up in most patients. GSV is preferred as an interposition graft compared to a BaV.