Long term outcomes of ‘Christmas Tree’ banding for haemodialysis access induced distal ischemia: A 13-year experience

Ravindhran, Bharadhwaj; Totty, Joshua P.; Sidapra, Misha; Lathan, Ross; Carradice, Daniel; Chetter, Ian C.; Smith, George E.

Abstract

Background: The reduction in distal arterial flow following arteriovenous fistula (AVF) creation can cause a perfusion deficit known as haemodialysis access induced distal ischemia (HAIDI). Various techniques have been advocated to treat this difficult problem with varying success. We present the long-term outcomes following a novel banding technique. Methods: 46 patients in this cohort from 2008 to 2021 underwent a novel banding procedure using a Dacron™ patch shaped with one slit-end and saw-tooth edges (resulting in a ‘Christmas-tree’ pattern) to provide a ratchet mechanism to progressively constrict the fistula outflow. Real-time finger perfusion pressure monitoring allowed an accurate reduction in AVF flow whilst increasing distal arterial perfusion pressure. Baseline characteristic were recorded and Kaplan-Meier survival curves were obtained to calculate the post-intervention primary, assisted primary and secondary patency. Results: 29 patients presented with rest pain and 11 presented with tissue loss due to distal ischemia. The post-intervention primary access patency was 100%, 98%, 78% and 61% at 30, 60 and 180 days and 1 year respectively. Complete resolution of symptoms was achieved in 74% (n = 34) of patients and a partial response needing no further intervention was achieved in 11% (n = 5) of patients. A Youden index calculation suggested that digital pressures of 41 mm Hg or lower in an open AVF were highly sensitive for symptomatic hand ischemia whereas pressures greater than 65 mm Hg ruled out distal ischemia. Conclusion: ‘Christmas-tree’ banding with on table finger systolic pressures is not only an efficacious and durable method for treating HAIDI but also preserves fistula patency.

Citation

Ravindhran, B., Totty, J. P., Sidapra, M., Lathan, R., Carradice, D., Chetter, I. C., & Smith, G. E. (in press). Long term outcomes of ‘Christmas Tree’ banding for haemodialysis access induced distal ischemia: A 13-year experience. The journal of vascular access, https://doi.org/10.1177/11297298221141497

• Journal Article Type: Article
• Acceptance Date: Nov 8, 2022
• Online Publication Date: Dec 6, 2022
• Deposit Date: Feb 16, 2023
• Publicly Available Date: Feb 23, 2023
• Journal: Journal of Vascular Access
• Print ISSN: 1129-7298
• Electronic ISSN: 1724-6032
• Publisher: Wichtig
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/11297298221141497
• Public URL: https://hull-repository.worktribe.com/output/4164957