Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function

Korsheed, Shvan; Eldehni, Mohamed Tarek; John, Stephen G.; Fluck, Richard; McIntyre, Christopher W.

doi:10.1093/ndt/gfq851

Cited by 111 publications

(108 citation statements)

References 30 publications

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“…This physiology is in part appreciated in patients receiving peripheral arteriovenous fistula for dialysis, with a reduction in SVR of 17% soon after fistula formation. 3 Antihypertensive drug therapy has disparate effects on hemodynamics depending on drug class The central iliac arteriovenous anastomosis is a unique solution to hypertension in patients with reduced aortic compliance, a situation where neurohormonal interventions would not be anticipated to have substantial impact. The reduction in BP and SVR that we report is immediate and far greater in magnitude than alternative treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Antihypertensive Effects of a Central Arteriovenous Anastomosis Are Mediated Through Profound Reduction in Systemic Vascular Resistance

Saxena

Sobotka

Hamshere

et al. 2016

Circ: Cardiovascular Interventions

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Device-based therapies increase therapeutic options for the treatment of hypertension for patients who fail polypharmacy because of adverse reactions or choice. Here we report the physiology related to a device, which uniquely addresses the structural pathogenesis of hypertension. Creation of a fixed-size central arteriovenous anastomosis mechanically causes an immediate and significant reduction of blood pressure (BP). 1 We present the first detailed hemodynamic findings before and after implantation of the ROX Coupler. CaseA 74-year-old white female with longstanding isolated systolic hypertension complicated by multiple drug intolerances was referred for treatment of her hypertension. She could only tolerate liquid furosemide 20 mg daily, which lowered her office BP from 220/100 mm Hg to 190/90 mm Hg. She exhibited features of raised arterial stiffness with increased pulse pressure and pulse wave velocity, and it was felt that sympathomodulation would not be beneficial for BP control. An arteriovenous anastomosis was created using the ROX coupler, inserted in a standard catheterization laboratory setting under fluoroscopic guidance via an endovascular approach through the femoral vessels ( Figure 1).2 In situ, the coupler creates a fixed-caliber 4 mm conduit between the external iliac artery and vein, transferring 0.8 L/min of blood from the arterial to the venous compartment. The hemodynamic changes in relation to coupler placement were evaluated with left and right heart catheterization, pulse wave velocity, office BP, and ambulatory BP measurement (Tables 1-3). The opening of the arteriovenous coupler immediately leads to a large reduction in mean arterial pressure of 13% because of a profound reduction in systemic vascular resistance (SVR) by 38% on the table (Figure 2). In tandem, there are increases in stroke volume (24%), cardiac output (39%), and HR (14%) because of the proximal arteriovenous shunt. Of note, pulmonary vascular resistance was seen to immediately decline (−46%), despite an increase in pulmonary flow possibly because of improved central oxygenation. At 6-months post anastomosis formation, repeat catheterization demonstrated greater reductions in SVR (−50%) and mean arterial pressure (−24%) compared with baseline, accompanied by further increase in cardiac output (46%), stroke volume (67%), and pulmonary vascular resistance (53%). There were also large, immediate (1-day postcoupler) and durable (6-months post-coupler) reductions in office BP and ambulatory BP parameters at 6-months, with no change to the baseline medication regimen and no change in exercise capacity. The reduction in weight of 1 kg (2%) suggests that total body volume is largely unchanged after central arteriovenous anastomosis. DiscussionThe opening of the 4-mm, fixed diameter, central arteriovenous conduit leads to utilization of a proximal, low resistance, high compliance central venous segment in parallel with the aorta and results in an immediate and significant reduction in SVR (−38% with coupler opening and −50% at...

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Section: Discussionmentioning

confidence: 99%

Antihypertensive Effects of a Central Arteriovenous Anastomosis Are Mediated Through Profound Reduction in Systemic Vascular Resistance

Saxena

Sobotka

Hamshere

et al. 2016

Circ: Cardiovascular Interventions

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“…These data state that the lower mortality of these patients with AVF, may be due to factors beyond VA associated infections and dysfunctions [152]. However, data from 1996 to 2006 collected from DOPPS indicate a growing use of catheters in many countries [153].…”

Section: Final Remarks and Conclusionmentioning

confidence: 98%

Vascular Access for Hemodialysis

Pantelias¹,

Grapsa²

2011

Technical Problems in Patients on Hemodialysis

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“…A larger study (40 active patients and 40 controls) showed that at 6 months the AVF group showed a significant reduction in the office BP as well as in the ABP levels. 16,17 The novel technique was shown to be effective, but a third of AVF patients developed ipsilateral venous stenosis, which resolved after stenting or venoplasty. This unique promising procedure awaits further testing and additional research studies.…”

Section: Central Arteriovenous Coupler Therapy For Resistant Hypertenmentioning

confidence: 99%

Device-based Therapies for Resistant Hypertension: Current Status

Wali¹,

Ram²

2017

Hypertension Journal

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Resistant hypertension is a serious consequence of uncontrolled hypertension. This condition can lead to significant target organ damage. Individuals with resistant hypertension are highly vulnerable to excessive morbidity and premature mortality. Hence, it is important to recognise resistant hypertension as a distinct clinical entity. Whereas aggressive medical therapy is indicated to control resistant hypertension, there is a growing interest and considerable ongoing research on the role of mechanical device based approaches to control hypertension. Although the results of device based therapy of resistant hypertension are inconsistent, this alternative approach should be pursued further by newer research protocols and novel methodology.

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Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function

Cited by 111 publications

References 30 publications

Antihypertensive Effects of a Central Arteriovenous Anastomosis Are Mediated Through Profound Reduction in Systemic Vascular Resistance

Antihypertensive Effects of a Central Arteriovenous Anastomosis Are Mediated Through Profound Reduction in Systemic Vascular Resistance

Vascular Access for Hemodialysis

Device-based Therapies for Resistant Hypertension: Current Status

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