Hemodynamic Effects of Arteriovenous Shunts Used for Hemodialysis

Johnson, George; Blythe, William B.

doi:10.1097/00000658-197005000-00010

Cited by 76 publications

(30 citation statements)

References 8 publications

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“…Other complications like thrombosis, infection, and revisions which have been reported to occur in 25-30°/» of patients with peripheral shunts [8,12], were not encountered in these patients. Also, no untoward cardiac manifestations were noted as a result of these shunts even in small children, and this is in keeping with the findings of J ohnson and Blythe [7]Follow-up studies of these patients, demonstrated the reestablishment of normal circulation through the distal brachial artery and its ulna and radial branches, within a very short time after the construction of the shunt. Angiographic studies carried out 1-3 weeks after shunting clearly demonstrated that adequate refilling of the distal segment of the brachial artery takes place fairly rapidly from the superior ulna collateral and the profunda brachii through the lower ulna collateral and the arterial anasto moses around the elbow joint.…”

Section: Discussionsupporting

confidence: 87%

Brachial Arteriovenous Shunts for Hemodialysis and Extracorporeal Procedures

Abouna¹

1973

Eur Surg Res

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Fourteen patients aged 8–47 years were : given brachial arteriovenous shunts. The main indications were a combination of hemodialysis, hepatic assist and intravenous feeding. Five patients were children under 16 years with small peripheral vessels. All shunts were constructed under local anesthesia through a single 5-cm incision in the lower third of the upper arm. A segment of brachial artery just proximal to a major collateral branch and the adjacent basilic vein were used. Shunts were used intermittently for 8 days-7 months and were electively removed when no longer required. Clot formation, sepsis, and functional or circulatory impairment were not encountered. Flow studies showed a peak ‘free’ flow of 200–400 ml and an ‘assisted’ flow, with a pump on the arterial side, of 300–600 ml/min. Angiographic studies showed presence of good collateral vessels and reestablishment of normal flow and pulses in the distal radial and ulnar arteries within 7–14 days. The precise indications for brachial shunts and the surgical techniques employed are described.

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Section: Discussionsupporting

confidence: 87%

Brachial Arteriovenous Shunts for Hemodialysis and Extracorporeal Procedures

Abouna¹

1973

Eur Surg Res

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“…An increased CO, in conjunction with higher arterial blood oxygen content, could improve total DO 2 . Indeed, it has been well-documented that arteriovenous fistulae increase CO 3,4 and arterial oxygen saturation 5 and that an increase in CO is accompanied by an increase in MVO 2 . 6,7 Likewise, exerciseinduced arterial desaturation has been shown to be less pronounced after creation of an AVS.…”

Section: Discussionmentioning

confidence: 99%

“…The creation of an extracardiac arteriovenous shunt (AVS) has been demonstrated to increase MVO 2 , CO, and total DO 2 . [3][4][5][6][7] It is therefore conceivable that creation of an AVS may improve functional capacity in patients with COPD. Indeed, an improvement in 6-minute walking distance (6MWD) and increase in CO in patients with endstage COPD who underwent predominantly surgical creation of an arteriovenous fistula has been reported.…”

mentioning

confidence: 99%

Percutaneous Femoral Arteriovenous Shunt Creation for Advanced Chronic Obstructive Pulmonary Disease

Bertog

Kolmer

Kleschnew

et al. 2012

Circ: Cardiovascular Interventions

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Background— Advanced chronic obstructive pulmonary disease causes a significant reduction in functional capacity because of dyspnea and fatigue, partially related to hypoxemia and compromised oxygen delivery. Percutaneous creation of an arteriovenous shunt may increase oxygen delivery and, hence, improve patients' functional capacity. Methods and Results— This is a prospective, single-center, proof-of-concept pilot study. Patients with advanced chronic obstructive pulmonary disease underwent percutaneous arteriovenous shunt creation. End points were the change in 6-minute walking distance; quality of life, measured by St George's Respiratory Questionnaire; and physiological parameters at 12-week follow-up. Fifteen patients underwent percutaneous arteriovenous shunt creation. Cardiac output and oxygen delivery increased significantly from 4.1 L/min at baseline to 5.9 L/min at 12 weeks ( P <0.01) and from 751 mL/min at baseline to 972 mL/min at 12 weeks ( P <0.01), respectively; however, there was a trend toward a significant decrease in the 6-minute walking distance between baseline (338 m) and 12-week follow-up (294 m) ( P =0.07). There was no significant difference in the St George's Respiratory Questionnaire score, oxygen saturation, or lung function tests. Lower extremity edema, venous stenosis, right heart failure, and deep venous thrombosis occurred in 10, 7, 4, and 4 patients, respectively. Conclusions— Though it causes a significant increase in cardiac output and oxygen delivery , the creation of an arteriovenous shunt in the setting of severe chronic obstructive pulmonary disease did not improve functional capacity or quality of life. A significant number of adverse events occurred. This concept cannot be recommended for routine clinical use in unselected patients with advanced chronic obstructive pulmonary disease.

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“…The hemodynamic effects of a left-to-right shunt have been well described (table 1) [7,8,9,10]. With creation of an AVF, there is an immediate drop in peripheral vascular resistance, which leads to an immediate, compensatory increase in cardiac output (CO).…”

Section: Cardiac Toxicitymentioning

confidence: 99%

Arteriovenous Fistula Toxicity

et al. 2011

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The arteriovenous fistula (AVF) has been a mainstay of hemodialysis treatments and the preferred access route since its inception in the 1960s, due to its longevity and resistance to infection. However, the AVF is not benign. There is significant primary failure, as well as cardiac, vascular, and other, less well recognized, complications. Together, they represent toxicity, to which considerable morbidity and mortality can be attached. Official policy, based on guidelines where AVF toxicity is given short shrift, drives an increase in use of these devices, and may have undesired consequences.

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Hemodynamic Effects of Arteriovenous Shunts Used for Hemodialysis

Cited by 76 publications

References 8 publications

Brachial Arteriovenous Shunts for Hemodialysis and Extracorporeal Procedures

Brachial Arteriovenous Shunts for Hemodialysis and Extracorporeal Procedures

Percutaneous Femoral Arteriovenous Shunt Creation for Advanced Chronic Obstructive Pulmonary Disease

Arteriovenous Fistula Toxicity

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