How much to downsize in case of shortening of the fistula tract

Issue: How much should I downsize in case of shortening of the fistula tract

In case the natural subsiding of edema requires downsizing the prosthesis, it is advisable to downsize not more than one length. It is mostly sufficient to downsize only one size/length, e.g. from 12.5 to 10 mm, or from 8 to 6 mm. Downsizing two sizes might result in a ‘perfect’ fit and initially might look good, but if some edema develops, the device might rapidly become too short or reactive granulation may occur. Furthermore, the system has a good tolerance and a slightly too long prosthesis causes less trouble than a tight fitting one. As can be seen from the graph to the left (from Op de Coul et al. 1999) downsizing more than one size is rarely indicated and in fact should be discouraged for the above mentioned reason.