Graft Inclusion Technique – A Unique and Promising Technique of Flow Reduction for High-flow Arteriovenous Fistula in Chronic Kidney Disease Patient

Background: High-flow arteriovenous fistula (AVF) in chronic kidney disease (CKD) patients can lead to complications and challenges in vascular access management. Preserving access while reducing flow is essential for patient care. Objective: To describe the effectiveness of the graft inclusion technique (GIT) using a polytetrafluoroethylene (PTFE) graft in reducing flow in a high-flow brachiocephalic AVF (BC AVF) and preserving vascular access. Method: A CKD patient with a high-flow, aneurysmal left BC AVF underwent surgical intervention. The dilated vein was initially plicated, and a 6 mm PTFE graft was placed intraluminally. One end of the graft was anastomosed at the AVF anastomosis site and the other to the plicated vein. Result: Following the GIT procedure, there was a significant decrease in the AVF flow volume compared to preoperative levels, while vascular access was successfully preserved. Conclusion: Graft inclusion technique is an effective, reliable, and access-preserving option for reducing flow in high-flow arteriovenous fistulas in CKD patients.