Clinicians at a Fort Worth vascular access center wanted to ascertain the effects of banding their patients with high-flow arteriovenous fistulas. It is known that patients with high flow of more than 2 L/min are more likely to experience cardiac symptoms. Therefore, the nephrologists set a goal of reducing flow in the high-flow fistulas of 12 patients to between 600 and 1200 mL/min and then retrospectively analyzing the results.

Eighty percent of the patients had diabetes, and 41 percent already had coronary artery disease. Before banding, the average flow in the fistulas was 3,784 mL/min.

To track clinical improvements, the Transonic hemodialysis monitor was used to measure cardiac output and access flow every two weeks after the banding procedure and again at three and six months. 2D echo was performed at six months post-banding, in addition to the access flow measurements and clinical evaluation.

The clinicians found that by reducing the fistula flows to a mean of 1174 mL/min, their patients’ cardiac outputs decreased significantly as did their pulmonary systolic pressures and left ventricular mass indices. In fact, their heart failure (according to the New York Heart Association’s classification system) improved by one stage. Moreover, their need to return to a hospital for acute heart failure decomposition decreased significantly.

With the aid of a Transonic hemodialysis monitor for aggressive post-banding surveillance, the clinicians were able to substantiate the therapeutic benefits of banding their patients with high-flow fistulas to avert cardiac overload and reduce their need for hospitalization.

Side Bar:

The widely used New York Heart Association (NYHA) heart failure classification

• Class I: No limitation of physical activity
• Class II: Slight limitation of physical activity in which ordinary physical activity leads to fatigue, palpitation, dyspnea or anginal pain; the person is comfortable at rest
• Class III: Marked limitation of physical activity in which less-than-ordinary activity results in fatigue, palpitation, dyspnea or anginal pain; the person is comfortable at rest
• Class IV: Inability to carry on any physical activity without discomfort but also symptoms of heart failure or the angina syndrome even at rest, with increased discomfort if any physical activity is undertaken

Reference

Balamuthusamy S, Jalandhara N, Subramanian A, Mohanaselvan A. “Flow reduction in high-flow arteriovenous fistulas improve cardiovascular parameters and decreases need for hospitalization,” Hemodial Int. 2016 Jul;20(3):362-8. (Transonic Reference # HD11223AH).