TWO CASES OF NONINVASIVE CONTINUOUS STROKE VOLUME MONITORING BEFORE AND AFTER GRAFT INCLUSION TECHNIQUE FOR HIGH-FLOW ARTERIOVENOUS FISUTLAS

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Abstract Title *

TWO CASES OF NONINVASIVE CONTINUOUS STROKE VOLUME MONITORING BEFORE AND AFTER GRAFT INCLUSION TECHNIQUE FOR HIGH-FLOW ARTERIOVENOUS FISUTLAS

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Co-author 1

Noriko Makita noriko.tamura@med.uoeh-u.ac.jp University of Occupational and Environmental Health Second Department of Internal medicine, Kitakyushu Japan *

Co-author 2

Kenya Sanada k.sanada1107@gmail.com University of Occupational and Environmental Health Kidney Center Kitakyushu Japan -

Co-author 3

Tatsuomi Hamamoto t-hamamoto@clnc.uoeh-u.ac.jp University of Occupational and Environmental Health Clinical Engineering Kitakyushu Japan -

Co-author 4

Emi Hasegawa emily0319noah@yahoo.co.jp University of Occupational and Environmental Health Kidney Center Kitakyushu Japan -

Co-author 5

Kazutoshi Nakazono knakazono@med.uoeh-u.ac.jp University of Occupational and Environmental Health Kidney Center Kitakyushu Japan -

Co-author 6

Ryota Suga kendo_oita_aki@yahoo.co.jp University of Occupational and Environmental Health Second Department of Internal medicine, Kitakyushu Japan -

Co-author 7

Tomohiro Shirouzu t-shirouzu@med.uoeh-u.ac.jp University of Occupational and Environmental Health Second Department of Internal medicine, Kitakyushu Japan -

Co-author 8

Ryoto Fukuju fukuju5946@med.uoeh-u.ac.jp University of Occupational and Environmental Health Second Department of Internal medicine, Kitakyushu Japan -

Co-author 9

Tetsu Miyamoto tetsum@med.uoeh-u.ac.jp University of Occupational and Environmental Health Kidney Center Kitakyushux Japan -

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

High-flow arteriovenous fistulas(AVFs) can cause high-output heart failure, and surgical flow reduction is an effective strategy for reducing cardiac overload. The noninvasive continuous hemodynamic monitoring system (ClearSightⓇ)enables real-time evaluation of circulatory dynamics during hemodialysis and may provide valuable insights into the hemodynamic effects of flow reduction. In this presentation, we report two HD patients with high-flow AVF who underwent hemodynamic assessment using the ClearSightⓇ system before and after surgical shunt flow reduction.

Methods

Case presentation:

Case 1: A 68-year-old man with a left forearm AVF, who had been receiving HD for 11 years due to bilateral nephrectomy for renal cell carcinoma presented with left hand dorsum edema and was diagnosed with a high-flow AVF (brachial artery flow volume: 2200 ml/min). The patient underwent graft inclusion technique, resulting in a flow volume of 1300 ml/min. Postoperative stroke volume(SV) during HD session was significantly lower than preoperative SV (67.8±5.3 ml/beat vs. 75.9±4.3 ml/beat), as shown in the figure. Transthoracic echocardiography revealed a reduction in the left atrial diameter, left ventricular end-diastolic dimension, and stroke volume after flow reduction.

Case 2: A 69-year-old woman with a left forearm AVF, who had been receiving HD for 9 years due to diabetic nephropathy, developed symptoms of heart failure, such as dyspnea on exertion, which were not related to fluid overload. She was diagnosed with a high-flow AVF (brachial artery flow volume: 1700 ml/min) and underwent hemodynamic assessment before and after surgical flow reduction.

Results

Vascular access flow reduction surgery effectively decreases both cardiac preload and afterload in patients with high-flow AVFs. ClearSightⓇsystem provides a simple and practical novel method for evaluating cardiac overload during hemodialysis and may support the improved management of high-flow AVFs in clinical practice.

Conclusion

Here, we present two cases in which the effects of the graft inclusion technique on the SV during dialysis were visualized using the ClearSightⓇ system.

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