Breakthrough for patients on dialysis as PGI team develops safer, affordable solution for high-flow AV fistulae

Professor Vivek Lal, director PGIMER, stated, “This ground-breaking approach exemplifies how tailored, cost-effective solutions can revolutionise patient management, especially in resource-limited settings like ours. We are proud to lead in this field and improve the quality of life for our dialysis patients”.

Underpinning the affordability and cost effectiveness of the technique, professor H S Kohli, head, Department of Nephrology, PGIMER said, “The development of this technique has been a game-changer. It provides a safe, simple, and affordable option for managing high-flow arterio-venous fistulae, directly addressing a major complication in dialysis care.”

High-flow fistulae are common complications among dialysis patients. These fistulae, which are surgically created connections between an artery and a vein, are vital for effective dialysis. However, when a fistula’s flow rate becomes excessive, it can lead to increased pressure on the heart, resulting in heart failure, inadequate dialysis, and risks of fistula rupture.

Until now, managing such high-flow fistulae required complex procedures involving angiography, hospitalisation, and expensive equipment like catheterisation labs, often costing around Rs 50,000, posing a financial burden on patients and healthcare systems alike.

Recognising this challenge, a PGIMER team, led by professor Manish Rathi from the Department of Nephrology and supported by Dr Ajay Salwania from the Department of General Surgery, developed a simple yet effective banding technique that can be performed without the need for advanced imaging or hospitalisation.

Detailing about the technique, Rathi shared, “Over the past three years, we have successfully carried out this procedure for numerous patients, gaining the world’s largest experience with this approach. The procedure involves placing a controlled constriction on the fistula to reduce its flow, thereby alleviating cardiac strain and preventing further complications. It is performed as a day-care procedure, requiring no anaesthesia in most cases, and can be completed within a short outpatient visit.”

Rathi further detailed that this breakthrough method offers multiple benefits. The entire procedure costs approximately Rs 5,000 as compared to Rs 50,000 otherwise with traditional procedures, making it accessible to a broader patient population.

It is minimally invasive, eliminating the need for angiography or catheterisation labs, which reduces risk and shortens recovery time. Being a day-care procedure, patients can return home the same day, significantly enhancing convenience and reducing hospital stay.

“Our extensive experience and data have demonstrated high success rates, with sustained improvements in fistula function and cardiac health, providing a new lease on life for many patients suffering from high-flow fistula complications,” Rathi said.

The pioneering work has been recognised internationally, receiving the prestigious Best Paper Award two years ago, highlighting the contribution to advancing nephrology care.

“We plan to continue refining this technique and expanding its availability, ensuring that more patients benefit from this life-changing procedure,” Rathi concluded.