Original Paper Blood Purif 2002;20:557–562 DOI: 10.1159/000066960 Hemodynamics of Venous Cuff Interposition in Prosthetic Arteriovenous Fistulas for Hemodialysis Susan Lemson a,d Jan H.M. Tordoir a,d Raja Ezzahiri a Karel M.L. Leunissen b,d Peter J.E.H.M. Kitslaar a,d Arnold P.G. Hoeks c,d Departments of a Surgery and b Nephrology, University Hospital Maastricht, c Department of Biophysics, and d Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands Accepted: June 17, 2002 Dr. J.H.M. Tordoir Department of Surgery, University Hospital Maastricht PO Box 5600 6202 AZ Maastricht (The Netherlands) Tel. +31 0 43 387 5491, Fax +31 0 43 387 5473, E-Mail j.tordoir@surgery.azm.nl ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2002 S. Karger AG, Basel 0253–5068/02/0206–0557$18.50/0 Accessible online at: www.karger.com/bpu Key Words Arteriovenous fistulas W Hemodialysis W Intimal hyperplasia W Venous cuff W Hemodynamics Abstract Purpose: The durability of prosthetic arteriovenous fistu- las (AVF) for hemodialysis is jeopardized by thrombotic occlusions due to intimal hyperplastic stenoses. In arteri- al reconstructive surgery, peripheral arterial bypasses with prosthetic material benefit from a venous cuff at the distal anastomosis. Therefore, a study was performed to assess the effect of a venous cuff at the venous anasto- mosis of PTFE graft AVFs in terms of stenosis develop- ment, hemodynamics and patency rates. Methods: A subset of 40 patients from a multicenter study were enrolled into the study, of which 20 patients were ran- domized for venous cuff interposition. Duplex measure- ments to detect stenoses and volume flows were per- formed at 6, 12, 26 and 52 weeks postoperatively. Rela- tive distension (RD) and wall shear rate (WSR) were cal- culated by means of vessel wall Doppler tracking (VWDT). Results: The total number of stenoses was sig- nificantly less in the cuff group (21 vs. 33; p = 0.045). This feature was found at the site of the venous anastomosis (cuff 5; no cuff 12). Volume flow, graft and efferent vein diameters, RD and WSR in the graft and efferent vein were comparable for both groups. WSR in the venous anastomosis tended to be lower in the cuff group (768 vs. 1,448 s –1 , p = 0.068).Volume flows and WSR were signifi- cantly lower in failing grafts. Patency rates were similar in both groups (primary patency 13 vs. 29%; secondary patency 78 vs. 67%). Conclusions: A venous cuff at the venous anastomosis of PTFE graft AVFs results in less stenoses, but improved patency rates could not be dem- onstrated. Copyright © 2002 S. Karger AG, Basel Introduction Polytetrafluoroethylene (PTFE) grafts are increasingly used as vascular access for hemodialysis, because of fail- ure of radiocephalic AVFs or the lack of suitable vessels to create a native AVF. Graft thrombosis or stenosis are the main reasons for acute or elective interventional treat- ment, leading to a high morbidity and hospital admis- sions. Intimal hyperplastic stenoses, at the site of the venous anastomosis or in the efferent vein [1–3], usually Supported by the Dutch Kidney Foundation