Upper Extremity Arteriovenous Fistulas Induce Modest Hemodynamic Effect on the In Situ Internal Thoracic Artery

Rahbar, Rodeen; McGee, William; Birdas, Thomas J.; Muluk, Satish C.; Magovern, James A.; Maher, Thomas D.

doi:10.1016/j.athoracsur.2005.06.018

Cited by 28 publications

(25 citation statements)

References 7 publications

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“…A second report showed that the blood flow was similar in ipsilateral and contralateral in situ ITAs in 12 hemodialysis patients with upper extremity AVFs but without CABG (11). The largest published study on this topic included 155 patients and did not show any increase of risk of death or cardiac events after ITA CABG in HD patients having ipsilateral AV access, contradicting our study (13).…”

Section: Discussioncontrasting

confidence: 53%

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Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

et al. 2017

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Background The possibility of coronary steal through an arteriovenous fistula (AVF) in hemodialysis (HD) patients with coronary artery bypass grafts (CABGs) using an ipsilateral internal thoracic artery (ITA) has been suggested. In order to define the significance of such a possibility, we analyzed cardiac events and mortality risk in patients in relation to AVF flow. Methods A retrospective cohort study was performed on prevalent HD patients from a single center. The outcomes included a first cardiac event, cardiac death and death from any cause. Results The group consisted of 23 chronic HD patients having ITA CABG and upper extremity AV access, 12 patients had an ipsilateral and 11 patients had a contralateral location of ITA CABG and an upper extremity AV access. The mean follow-up period was for 37.0 months. Multivariable Cox proportional-hazards regression analysis of risk of death from any cause in relation to AV access flow showed no increased risk, neither in the group with ipsilateral location of ITA grafts and dialysis accesses (adjusted HR, 3.047 [95% CI, 0.996 to 1.000], p = 0.081), nor in the group with contralateral location of both shunts (adjusted HR, 0.173 [95% CI, 0.997 to 1.002], p = 0.678). There was no significant correlation between AV access blood flow and the risk of first cardiac event as well as cardiac death in either study group. Conclusions In this study on HD patients having ipsilateral ITA CABG and AVF, fistula flow rate was not found to be associated with mortality or cardiac risk.

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Section: Discussioncontrasting

confidence: 53%

“…This issue remains controversial since an additional three reports failed to show evidence of a coronary steal (11)(12)(13).…”

Section: Discussionmentioning

confidence: 97%

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

et al. 2017

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“…In a small study by Rahbar and colleagues, mean fl ow velocity calculations failed to identify any statistically signifi cant diff erences between the ipsilateral and contralateral IMA in diff erent fi stula states (fi stula open or occluded and during hemodialysis) [16]. However, data were available in only twelve patients, but the PSV in the IMA increased from 89.0 (± 20.0) cm/s to 97.1 cm/s (± 27.4) during fi stula occlusion, which was statistically not signifi cant.…”

Section: Discussionmentioning

confidence: 99%

Vertebral and internal mammary artery steal syndrome in patients with hemodialysis access

Thalhammer

Clemens

Valentin

et al. 2016

Vasa

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Summary:Background: Increased fl ow in the subclavian artery feeding a vascular access for hemodialysis can induce steal phenomena in the vertebral (VA) and internal mammary artery (IMA). The aim of this study was to describe the hemodynamic effects of access fl ow on the VA and IMA in patients with native fi stulas and grafts. Patients and methods: Peak systolic (PSV) and end diastolic (EDV) velocity measurements of the VA, IMA and carotid arteries, as well as fl ow volume measurements of the subclavian artery, were performed. Flow measurements at the side of the vascular access were compared with the contralateral side. Fifty-fi ve patients were consecutively included, most with a radio-cephalic fi stula on the left arm with a mean shunt volume of 1156 ml/min. Results: Pathologic fl ow patterns were observed in the ipsilateral VA in four patients (7.3 %); contralateral VA fl ow was normal in all patients. Peak systolic velocity of the VA was signifi cantly decreased at the side of the shunt arm with a PSV of 42.6 ± 11.8 cm/s compared to 48.4 ± 15.6 cm/s contralateral (p < 0.05). The IMA fl ow pattern were normal in all patients. The PSV of the IMA was signifi cantly decreased (p < 0.01) at the side of the shunt arm (87.5 ± 29.1 cm/s) compared to the non-shunt arm (95.9 ± 27.4 cm/s). Conclusion: We describe signifi cant hemodynamic effects of fi stulas to the vertebral and internal mammary arteries. Doppler spectral analysis of the vertebral and internal mammary arteries should be integrated in ultrasound, especially in patients with cerebrovascular or cardiac symptoms.

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“…Current practice in dialysed patients undergoing CABG surgery, is to use the ITA on the opposite side of the shunt, or a free ITA graft, if preoperative angiography reveals a retrograde diastolic flow (i.e., steal) in the ipsilateral ITA [3]. Only a few reports and small studies have examined the interference between upper extremity AV fistulae and ipsilateral ITA used as coronary grafts, with controversial results [1,2]. ter CABG surgery, due to renal failure requiring haemodialysis, a left brachiocephalic AV fistula was created.…”

Section: Discussionmentioning

confidence: 99%

“…Reports exist on the occurence of a coronary steal phenomenon in this situation, if the ipsilateral ITA is used as a coronary artery bypass graft (CABG) [1]. However, evidence regarding this matter is conflicting [2]. We report the case of a 69-year old woman, undergoing chronic haemodialysis, who was admitted to our hospital due to typical angina pectoris and transitory ST segment elevation in two precordial leads (V1-V2), with angiographic evidence of coronary steal phenomenon at rest.…”

Section: Case Reportmentioning

confidence: 99%

Coronary steal phenomenon due to ipsilateral upper extremity arteriovenous fistula in a patient with internal thoracic artery bypass graft: an alternative treatment strategy

2012

Cardiovasc Med

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Upper Extremity Arteriovenous Fistulas Induce Modest Hemodynamic Effect on the In Situ Internal Thoracic Artery

Cited by 28 publications

References 7 publications

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

Effect of hemodialysis access blood flow on cardiac events after coronary artery bypass grafting using an internal thoracic artery

Vertebral and internal mammary artery steal syndrome in patients with hemodialysis access

Coronary steal phenomenon due to ipsilateral upper extremity arteriovenous fistula in a patient with internal thoracic artery bypass graft: an alternative treatment strategy

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