Physiologic Response Patterns to Occlusion of Clinically Significant Arteriovenous Fistulas

Abstract

Seven patients with hemodynamically significant arteriovenous fistulas for dialysis angioaccess were studied by multivarient computer analysis of physiologic data derived from cardiogreen dye dilution curves and A-VO2 before and after acute occlusion of their fistulas and prior to clinical therapy. Three patterns of response were characterized. These patterns seemed to be related to the innate ventricular contractility status, the type of medications, the presence of autonomic neuropathy, and their interplay with alterations in preload and afterload with fistula occlusion. In one patient, the response pattern precluded banding or occlusion of the fistula. In the remainder, the physiolobic responses permitted treatment by banding or occlusion. It seems advisable to adequately evaluate the physiologic response patterns of patients with hemodynamically significant arteriovenous fistulas prior to definitive treatment.