Banding for Hyperflow of Native Arterivenous Fistula: A Case Report in Andre Festoc Center in Bamako

Introduction: The native arteriovenous fistula (AVF) for hemodialysis is the surgical anastomosis between a neighboring artery and vein in order to have sufficient blood flow for hemodialysis [5] .These vascular approaches can have complications such as hemorrhage, thrombosis, infection, stenosis, aneurysm, high flow and distal limb ischemia [ 6] . Arteriovenous fistula hyperflow for haemodialysis is defined as a fistula flow rate in excess of 1.5 liters per minute [1-2].

Observation: This is a 47-year-old patient, followed for 07 years for progressive hepatitis B, diagnosed with CKD since 2020. She benefited from a humerobasilic AVF (with which she was dialyzed for 03 years) and was referred to us for management of hyperflow on the AVF. The patient presented with bleeding at the AVF puncture sites after each session, with hemostasis becoming increasingly difficult through compression. This prompted a Doppler ultrasound, which revealed a hyperflowing AVF (flow rate 2840ml/min). The left humeral AVF showed a significant flutter and a high-intensity thrill. Doppler ultrasonography of the AVF revealed hyperflow of the proximal AVF at 2340ml/min over the brachial artery. The basilic vein was patent, with a diameter of 9.6mm and a depth of 2.9mm. No stenosis or aneurysm on the AVF. The patient was offered two treatment options: banding of the AVF or ligation of the AVF combined with fabrication of a new AVF on the contralateral upper limb. Banding was therefore carried out. The outcome was favorable, with AVF flow reduced to a quarter of the initial rate.

Keywords: Banding, Arteriovenous Fistula, Hyperflow, Festoc Center, Bamako.