The number of patients with chronic kidney disease on regular hemodialysis is continuously increasing and reached 340000 with is as many as one in 359 general population of Japan. Along with the increase of hemodialysis patients, demand of flow volume reduction surgery for complicated hemodialysis access, such as high flow arterio-venous fistula (AVF), edema of AVF limb, ischemia of the AVF limb is also increasing. Banding of the conduit is common procedure of choice for patients require flow volume reduction, but high ratio of thrombosis of AVF, recurrence of high flow is reported. High patency rate after the procedure and stable flow volume reduction over the long term are expected for flow volume reduction surgery. We performed flow volume reduction by using 4 mm diameter prosthetic graft in 7 patients. Average length of the 4 mm graft was 15 cm, mean confirmed patent period is 700.9 days. One patient lost access due to thrombosis of the conduit. Mean flow volume at the referral was 2330 ml/min, and mean flow volume after the procedure was 701 ml/min.

The flow volume reduction surgery using 4 mm prosthetic graft may be regarded to has sufficient flow volume reduction and patency.

Tsuyoshi Ichinose, MD is a board-certified cardiovascular and vascular surgeon currently serving in the Department of Peripheral Vascular Surgery at Tokyo University of Science. With over 15 years of clinical experience, he has held key positions in leading institutions, including IMS Tokyo Katsushika General Hospital, where he was Chief Vascular Surgeon. He earned his medical degree from Hirosaki University and completed advanced surgical training at Tokyo Medical and Dental University. He holds multiple certifications in endovascular procedures, including aortic stent grafts and endovenous thermal ablation. He is actively involved in professional societies such as the Japan Surgical Society, Japanese Society for Vascular Surgery, and the Asian Society for Vascular Surgery. Known for his expertise in complex vascular interventions and dedication to clinical excellence, he continues to contribute to the advancement of vascular surgery both nationally and internationally