A case of blood flow control surgery using Graft Covering Technique for excessive blood flow in upper arm AVF

Previously, we reported that the Graft Covering Technique (GCT) yields good results as a method of blood flow control surgery for excessive blood flow in an arteriovenous fistula (AVF). It was performed for forearm AVF. This time, we applied GCT for excessive blood flow in upper arm AVF. A 70-year-old woman underwent GCT because of shunt vascular pain and excessive blood flow 3 years after superficialization of the brachial artery and placement of an internal shunt using the cephalic vein. The procedure consisted of closing the existing AVF, exfoliating the shunt vein, inserting that into the shortened vascular graft (covering), reconstructing AVF, and suturing the graft and anastomosis at several locations to fix it. After surgery, vascular pain disappeared and brachial blood flow decreased from 1910 to 1046 mL/min. Although reconstruction was performed at a proximal site, the shunt vein could be punctured for both blood withdrawal and blood return. GCT was considered to be useful for excessive blood flow in upper arm AVF.