The Effect of the Formation of an Arteriovenous Fistula Upon Blood Volume 1

Abstract

The creation of a large peripheral arteriovenous fistula results in a series of related physiologic adjustments, including changes in cardiac output, intravascular and intracardiac pressures, blood flow to peripheral organs and urinary excretion of water and electrolytes (1-3). The changes in blood volume which occur under these circumstances have been the subject of controversy, partly because observations made before and after surgical extirpation of a fistula are necessarily complicated by the effects of a major operation and the patient's convalescence.Previous efforts to resolve this question have utilized protein-binding dyes such as T-1824 or Brilliant Vital Red to measure blood volume. However, the accuracy of T-1824 as a measure of total blood volume is open to question (4) and its validity as an index to the intravascular volume of plasma in certain conditions has been challenged (5, 6). For these reasons it was decided to reinvestigate the early effect of an experimental arteriovenous fistula upon blood volume, and to use labelled red cells as well as T-1824 in an attempt to measure by independent methods changes in the volume of red cells and plasma. METHODSSeven trained mongrel dogs, weighing 10 to 18 kilograms, were fed a standard meal diet to which raw meat and ferrous sulfate were added. After control measurements of blood volume in the unanesthetized, fasting state, an arteriovenous fistula approximately one cm. long was created surgically between the abdominal aorta and the inferior vena cava, halfway between the renal vessels and the bifurcation. From two to six weeks after the operation, the blood volume was remeasured.Five cc. of the dog's own blood were incubated at room temperature for 30 minutes with P'. After labelling, the red cells were washed three times with cold 1

Blood volume and body fluid compartments in lambs with aortopulmonary left-to-right shunts.

“…A freshly prepared solution containing the three indicators was injected into the pulmonary artery. Blood samples (2-4 ml) were withdrawn from the aortic catheter just before and at 3,6,9,12,15,20,25,30,40,50,60,75,90,105,120,135,150,165,and 180 min after the injection for determination of the concentration of the indicators. The sample withdrawn before the injection served for obtaining a blank reference value.…”

“…One of the adaptations to a left-to-right shunt hence consists of an increase in blood volume as has been demonstrated in patients and dogs with arteriovenous fistulas (2,3). Although left-toright shunts caused by congenital heart defects lead to rather different hemodynamic situations than aortocaval left-to-right shunts, blood volume is also increased in children with left-toright shunts (4).…”

Συμβολή Εις Την Μελέτην Των Συγγενών Αγγειοδυσπλασιών Των Άκρων

“…Κατά τήν έξέτασιν ταύτηνπαρατηρεϊται διεύρυνσις τών παλ μικών κυμάτων άνωθεν τής άγγειοδυσπλασίας, προοδευτικώς αυξα νομένη μέ μέγιστον όριον, τό πλησιέστερον προς αυτήν, εν αντι θέσει προς τά κάτωθεν τής αγγειακής βλάβης τμήματα τοΰ άκρου, όπου τά παλμικά κύματα μειοϋνται προοδευτικώς. Συγκρινόμενα (COHEN 1948, EPSTEIN 1955, EICHNA 1960.…”