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Background and Aims During dialysis, if blood flow rate increases above 1500ml/min. there is an increase in pulsation and a high possibility of heart failure. In the long run, it can cause valvular disease and arrhythmia. In EDTA 2015, we presented a method of blood flow suppression for dialysis patients who had heart failure caused by excessive blood flow. However, within one year, 30% of the cases had relapsed. To solve this problem, we were able to prevent the recurrence of excess blood flow through improvement measures with a new device. Report including theoretical mechanisms. During vascular access excessive shunt blood flow creates a heavy load on cardiac function. Performing blood flow control surgery on dialysis patients with heart failure symptoms improves said function. Depending on the surgical method, it may recur. For this reason, we devised a surgical method that theoretically considers recurrence suppression. Method Clinical symptoms before surgery were based on trial hemodialysis patients with significant arrhythmia and shortness of breath at the time of exertion (6 males 4 females) using EPTFE of 4mm in diameter and 4cm in length or more replaced veins extended from anastomosis. (As shown in Poiseuille's law, it is necessary to replace veins with a shunt of smaller diameter but longer length than the vein being replaced.) The point of insertion at the anastomosis portion of the artery is 4mm. In order to connect to the larger section of the vein to the other end, it is cut diagonally to make the connection secure. During the operation, blood flow was monitored using ultrasound. The central side of the tibia artery was also tied off in some cases to control blood flow. Results Blood flow was reduced to 787 ml/min immediately after surgery from 1970ml/min before surgery, 1007ml after 6 months, and 721 ml/min after one year. Symptoms of arrhythmia disappeared in two patients during surgery and in all cases shortness of breath during exertion disappeared the day after surgery. Cardiac index improved three months after surgery in three cases. In none of the cases did we observe the complete rekindling of blood flow after one year. The average blood flow was less than 63% of the rate before surgery. Conclusion Replacement of 4cm or more length sections of veins with a 4mm diameter graft was useful in improving cardiac function in dialysis patients with heart failure.

P1355NEW SURGICAL TECHNIQUE TO CONTROL EXCESS VASCULAR ACCESS BLOOD FLOW