Proximal Radial Artery Ligation (PRAL) for Reduction of Flow in Autogenous Radial Cephalic Accesses for Haemodialysis

Abstract

Objective Juxta-anastomosis proximal radial artery ligation (PRAL) is a new surgical technique for reduction of excessive blood flow of radial cephalic fistulas (RCFs). Patients and methods This prospective study included 37 consecutive patients (eight children and 29 adults) who underwent PRAL of high-flow RCFs causing ischaemia ( n = 2), aneurysmal degeneration of the vein ( n = 14), and cardiac insufficiency ( n = 7) or for prevention of cardiac overload ( n = 14). Mean fistula age was 2.6 years for children and 7.4 years for adults. None had diabetes. Anatomical prerequisites (side-to-end anastomosis fistula and retrograde flow in the distal radial artery) were checked by ultrasound or angiography. Division and ligation of the juxta-anastomosis proximal radial artery were performed under regional anaesthesia. Patency following ligation was estimated according to the life table method. Results The success rate was 92% (34/37). The three failures included one excessive and two insufficient reductions of flow (<33%). Mean flow reduction rates were 50% in children and 53% in adults. Primary patency rates at 1 and 2 years were 88% ± 6% and 74% ± 9%, respectively. Secondary patency rates were 88% ± 6% and 78% ± 8%, respectively. Conclusion PRAL is a simple, safe, and effective technique for reduction of flow in RCFs.