Abstract: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 ad… Show more
“…Studies using the ROX Coupler in patients with COPD have shown no increase in arterial oxygen saturation 8,9 ; however, in the pilot study of Bertog et al, 9 there was an increase in arterial oxygen content (CaO 2 ) which, in combination with increased CO and blood flow, gave an increase in tissue oxygen delivery or DO 2 . One concern with a decrease in BP and preferential blood flow via a low resistance AV shunt is engagement of central and peripheral neurohormonal mechanisms that increase BP.…”
Section: Increased Oxygen Delivery To Tissuesmentioning
confidence: 99%
“…Increases in right atrial pressure, stroke volume, CO, and cardiac work have been documented in patients implanted with the ROX device. 8,9 The vascular system obeys an adaptation of Ohms law, known as Darcy law, where the flow through a tissue bed (Q) is proportional to the ratio between the pressure differential (ΔP) across the vascular bed and the resistance to flow (R), this can be expressed as Q=ΔP/R. In the normotensive setting, a reduction in SVR is compensated by an increase in CO, and BP is preserved.…”
Section: Reduction Of Bp Accompanying the Creation Of An Av Anastomosmentioning
confidence: 99%
“…Localized thigh peripheral edema has been seen in patients treated with the ROX Coupler and compression stockings are therefore advised for all patients. 8,9,11 …”
Section: Reduction Of Effective Arterial Volumementioning
confidence: 99%
“…8,9 Creation of an AV anastomosis results in an elevation in plasma levels of both atrial and brain natriuretic peptide and a decrease in plasma renin, 14,19 which further contribute to the decrease in SVR. Atrial natriuretic peptide is a potent vasodilatory hormone.…”
Section: Increased Right Atrial Pressure With Natriuretic Peptide Relmentioning
confidence: 99%
“…9 Given that hypoxia is a major vasoconstrictor in the lungs, raising the oxygen content of pulmonary arterial blood could potentially dilate the pulmonary vascular bed to increase perfusion. There may be knock on adaptive changes to nitric oxide production and endothelial function.…”
Section: Venous Oxygenation and Increased Pulmonary Blood Flowmentioning
“…Studies using the ROX Coupler in patients with COPD have shown no increase in arterial oxygen saturation 8,9 ; however, in the pilot study of Bertog et al, 9 there was an increase in arterial oxygen content (CaO 2 ) which, in combination with increased CO and blood flow, gave an increase in tissue oxygen delivery or DO 2 . One concern with a decrease in BP and preferential blood flow via a low resistance AV shunt is engagement of central and peripheral neurohormonal mechanisms that increase BP.…”
Section: Increased Oxygen Delivery To Tissuesmentioning
confidence: 99%
“…Increases in right atrial pressure, stroke volume, CO, and cardiac work have been documented in patients implanted with the ROX device. 8,9 The vascular system obeys an adaptation of Ohms law, known as Darcy law, where the flow through a tissue bed (Q) is proportional to the ratio between the pressure differential (ΔP) across the vascular bed and the resistance to flow (R), this can be expressed as Q=ΔP/R. In the normotensive setting, a reduction in SVR is compensated by an increase in CO, and BP is preserved.…”
Section: Reduction Of Bp Accompanying the Creation Of An Av Anastomosmentioning
confidence: 99%
“…Localized thigh peripheral edema has been seen in patients treated with the ROX Coupler and compression stockings are therefore advised for all patients. 8,9,11 …”
Section: Reduction Of Effective Arterial Volumementioning
confidence: 99%
“…8,9 Creation of an AV anastomosis results in an elevation in plasma levels of both atrial and brain natriuretic peptide and a decrease in plasma renin, 14,19 which further contribute to the decrease in SVR. Atrial natriuretic peptide is a potent vasodilatory hormone.…”
Section: Increased Right Atrial Pressure With Natriuretic Peptide Relmentioning
confidence: 99%
“…9 Given that hypoxia is a major vasoconstrictor in the lungs, raising the oxygen content of pulmonary arterial blood could potentially dilate the pulmonary vascular bed to increase perfusion. There may be knock on adaptive changes to nitric oxide production and endothelial function.…”
Section: Venous Oxygenation and Increased Pulmonary Blood Flowmentioning
A novel arteriovenous coupler for percutaneous placement in the iliac vasculature is under clinical investigation as a potential treatment modality for selected patients with uncontrolled hypertension. Initial results from patients with uncontrolled hypertension are expected in Autumn 2014.
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